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...

Monday, November 15, 2010

An unwillingness to Tolerate Discomfort v. An Unwavering Desire to Achieve a Dysfunctional Perfection...

With tempting and shiny promises of "just one more step...and then another..." OCD lures me on down its path of "sacrifice for the sake of sacrifice." 
Often refusal or resistance to doing exposure seems to be equated with an unwillingness to tolerate discomfort in the area of life that OCD affects.  Sometimes I squirm under under this assumption.  I want to say, "Wait, but being able to tolerate discomfort is what I pride myself on - my ability to force myself to do things when I really, really don't want to do them, especially things like compulsions.  Yes, compulsions can make things seem 'right.'  But often I really, really just don't want to do them, and yet I feel like I 'should' or 'have to' and I do them anyway despite the inconvenience they cause, despite their extremely onerous nature, and despite all the time and sacrifice they require.  I do this not so much because I don't want to deal with the discomfort of doing something wrong, but because I have such a strong, unwavering desire to do things 'perfectly,' even if attempting to achieve that arbitrarily-determined 'perfect' world renders me completely dysfunctional and unable to live a normal life."

In some ways, I feel like it's the opposite of an unwillingness or an inability to tolerate discomfort.  Instead it seems like the willingness to tolerate an extreme and infinite degree of discomfort in one very narrow part of life; an intense willingness to sacrifice for the sake of achieving a very focused, if misdirected, goal, and at whatever the cost in other areas of life.   Sometimes it's like I want to see how much I can tolerate, how much deprivation I can endure, how much pain and discomfort I can withstand in order to do things just as OCD says they should be done in some unattainable perfect world.  Instead of an unwillingness to tolerate discomfort driving the urge to perform compulsions, it's the unrelentingly and blinding desire to somehow do things "perfectly," (even if that 'perfect' is defined by OCD and is totally and completely unachievable in the real world), that often seems to drive my desire to perform rituals .  OCD doesn't care if it's standards aren't realistic.  It says I should do whatever possible, endure whatever it takes, to come as close to that 'perfect' world as I can.  And whatever discomfort that must be experienced along the way, so be it.  In fact, the degree of sacrifice, of pain, of discomfort endured for the sake of doing things "right" almost becomes an OCD badge of honor.   It's like the more unnecessarily terrible and difficult the task is made, the greater the accomplishment and the closer I am to reaching OCD's ideal of perfection. 

I feel like a lot of my OCD surrounds the constant desire to test my ability to endure for the sake of enduring.  If there is an easy way and a difficult way to go about something, both of which produce the same result, OCD declares that I must take the difficult route.  I have to, just to prove that I can.  Just to demonstrate to myself that I can MAKE myself do things despite the discomfort and drudgery they require.

One of the most poignant examples of this that I can remember comes from the eating disorder time of my life, when I was starving myself while simultaneously working out as hard as I could, draining myself of energy, of enthusiasm, of any desire to really do much else.  Just existing seemed like all I could endure.  And when I was finally dragged to the doctor and questioned about my habits, I felt somewhat shocked and offended when the doctor asked if I ever threw up or used laxatives to lose weight.   I didn't say it aloud, but in my head I was thinking.  "Never!  That's, that's like cheating...my goodness, that would be so NICE.  So EASY.  I could never allow myself to do those things, because that would indicate failure on my part to achieve thinness through sheer willpower and willingness to endure the exhaustion and pain that getting to this point requires.  That would be the shameful, lazy, failure way of getting results.  No.  If someone else can endure this sort of deprivation and suffering to lose weight, than I should be able to, too."

In the end I gained the weight back, felt like I was letting myself off the hook way too easily and without enough resistance to the process, learned pretty much nothing about the nature of EDs, and went on about my life without figuring out better ways to manage my strong perfectionistic tendencies and without learning about OCD at all.  I gradually stopped applying perfection to food and exercise and stopped testing my ability to endure sacrifice in that arena, but I continued on in others, especially in regard to schoolwork.

This willingness to endure discomfort to achieve some unrealistic and misguided sense of doing things just "right" carried on throughout the rest of high school, where my priorities went something like school > extracurriculars > sleep > taking care of myself  > relaxation and socialization and doing things for the sheer enjoyment of doing them.  And though my determination to do school just "right" at any and all costs lightened up in college, it was clear that I still sacrificed a lot for the sake of doing things "my" way. "My" way didn't even ensure better results, it just ensured that I always felt like I had tried, really really really really tried.

Even if I recognized that my overly-meticulous study habits sometimes hindered more than they helped, I forced myself to continue on.  My ability to achieve was important, but the ability to prove that I could make myself do things the most difficult and thorough way possible often seemed even more important.  And that's where I see this OCD theme once again - my inability to make changes to my rigid ways of studying even if I might actually be able to do just as well or maybe even better, and with far less effort and sacrifice, if I could just "let" myself ease up.  There's that cliche, "Don't work harder, work smarter."  Well, even when I readily recognized that there was a smarter, more efficient way to do something, I wouldn't let myself take it.  I made myself do it the hard way in order to feel like I had left no stone unturned, no possibility unconsidered, and in order to feel like I had endured and sacrificed to achieve.  Because how would I gain any sense of accomplishment any other way?   Sometimes I longed to give myself a break, to do something the "easy way" if it didn't really make a difference in the end result.  But those were also the times when that sacrifice seemed the most valuable.  When it was the most painful, and the most obviously non-essential, that was when that sacrifice was worth the most.  That was when it was real proof that I could endure for the sole sake of enduring.

Needless to say, I had, and still do have a warped way of achieving a sense of having done something "right."  Now I've just applied it to washing and cleanliness.  And I've done so in ways and with rules that are just as arbitrary, if not more so, than my ways and rules of studying.  I realize that washing this hand before the other hand, or for five less seconds here or there, doesn't make a difference in life.  I realize that touching this clean thing after touching that dirty thing doesn't really matter.  But because OCD is saying it does matter, because OCD is saying, "I don't care.  Just do it anyway to prove that you can endure, sacrifice, and accept any and all discomfort to achieve this faulty ideal of perfection, of orderliness," I am drawn to it.  I am pulled toward the desire to see if I can do whatever it takes, whatever the cost, to perfectly adhere to the totally arbitrary standard of perfection OCD has set before me in my mind.

I feel like there are two sides to driving force behind OCD.  First, there is the avoidance of discomfort, a desire to avoid the unwanted feelings that NOT performing compulsions brings about.  Second, there is the horribly tempting and everlasting pull towards some unattainable ideal, no matter how ridiculous, no matter the cost.  OCD waves that in front of me, "Saying, yes, yes, I know this is illogical.  I know there are minimal benefits that are most certainly outweighed by the costs.  But do it anyway, just to see if you can...don't you want to know?  Don't you want to try?  Don't you want to see what it feels like to know you can make yourself do something, no matter how pointless, for the sole sake of seeing if you could?"

Sometimes I feel like it's not so much the avoidance of discomfort but the loud siren call to achieve some dysfunctional idea of perfection that drives my behavior.  I don't do certain compulsions, and is it really that bad?  I'm not always sure.  Sometimes I feel like I have to MAKE myself uncomfortable by focusing on how I have violated my rules, how I have gone against the tenets of OCD, and by enumerating all the ways in which it screws up my way of maintaining my twisted sense perfection.  If I don't think so hard about it, it doesn't always bother me that much.  It isn't always that automatic.  But the desire, that magnetic pull to turn around, to make up for my transgressions against OCD and get back on its dysfunctional path, is still there, shining ever-so-brightly and ever-so-temptingly before me.

That said, I feel like it's not always so much an unwillingness to endure discomfort as a very, very lopsided distribution of that willingness that fuels my OCD.  On the one hand, I feel like my OCD is about seeing just how much discomfort I can make myself endure, and at what cost.  That willingness and desire to force myself to endure discomfort is just extremely concentrated in one very small part of my life, leaving not much for anything else.  The lure of enduring for the sake of enduring in an OCD-defined way combined with the lopsided distribution of my energy and drive to endure discomfort seem to be what gives OCD its power.  Somehow I need to tip the scales, to shift that drive so that I can use it to my benefit rather than be its slave.  Somehow I need to figure out how to harness that desire to force myself to do difficult things and use for the sake of battling rather than abetting OCD.

The thing is, this kind of work is hard and difficult in a very unconventional way - it's EASY.  It is so much EASIER than my usual way of doing things, and thus does not supply the same sense of suffering and sacrifice, feelings that, in some twisted way, seem to provide satisfaction.  I feel forced to obey OCD, and yet I am also drawn to it almost magnetically.  Turning the other way and not seeking out that feeling of doing something "right" often seems to require something that is not so much an ability to endure discomfort as an ability to endure a lack of discomfort.

How or why is it hard to not make things hard?  I don't know.  But I am trying to learn to do things the non-compulsive way, even if doing things that way doesn't provide that same sense of sacrifice.  Even it doesn't seem to beckon with the same lustrous sheen of the promises OCD is constantly dangling out in front of me - "just one more time, try just a little bit harder..." Because though it may feel good at first, trying to live up to OCD's misguided and ever multiplying commandments soon devolves into a race that is never quite over, with the sacrifices required growing ever greater to achieve the same sense of accomplishment.

Saturday, November 13, 2010

No Sleep...

I periodically do this thing where I decide that it's just not worth it to go to bed.  It's a bad habit, and I'm perpetuating that bad habit once again tonight.  I'm no longer in school.  The need for all-nighters has passed, and yet I still pull them, and mostly because of OCD.

This is how I ended up making the decision tonight:  I have an appointment at 8am.  Before I go to that appointment I'd like to shower, which means that, even though I have gotten my shower time down to under 30 minutes, I should probably be sure to be up and about by about 5:30 to make time for all the other OCD shenanigans that usually end up taking place before/after my shower and while I get ready.  That way I can be ready to leave by about 7:00/7:15 for my 8am appointment.  Woo.

Still not really a reason to stay up all night, right?  Well, there's more.  I woke up late today and had to head out to my office session without showering, which is something I like to before leaving the house for any reason.  This means that once I got back, I had no time limit, no hour that I had to shower by, because I didn't have to be anywhere.  And because I have grown to dislike showering so strongly, I just put it off and put it off and put it off, along with all the other activities that I felt like I couldn't tackle til after showering.  So as it gets later and later, the idea of having to shower, go to bed, and immediately shower again just seems pointless and daunting.  OCD says I can't sleep in my bed unless I shower; it also says that I should shower before my morning appointment.  And I don't want to take a second shower in the morning for virtually no reason other than OCD.  So I decide not to sleep.  Because I can't lie down in my bed until I have showered, but having to shower now and then again in a few hours seems like more than I can bear.

Oh, and I forgot to mention - in order to really actually sleep,  I have to take my Seroquel.  But it's hard for me to wake up in the morning if I do take it, especially if I have to get up really early.  So taking the Seroquel seems ill-advised if I want to make it to my appointment on time in the morning AND get ready beforehand.  So even if I could lay down in my bed, I probably wouldn't be able to fall asleep...

So here I am, writing about my OCD-induced all-nighter, while kind of wishing I could just lay down to relax my muscles and rest, even if I can't sleep.

I know that I will probably regret this tomorrow.  I will be tired and when I am tired my OCD gets worse.  I am at my best when I have a fairly normal schedule and go to bed and get up in the morning at a decent hour.  It's when I let things get all out of order like this that things get harder to manage.  Day and night begin to blend together, and I begin to use compulsive activity as some sort of artificial and unhelpful substitute for the structure that I'm missing.  

So here's a goal for this next week:  I will try harder to maintain a more normal schedule each day so that I don't end up in situations like the one I am in now.  When tempted to procrastinate showering, going to bed, or getting up the morning, I will try to remember what happens when I do this - a downward spiral of compulsivity and disrupted scheduling...

Wednesday, November 10, 2010

Still Chugging Along...


I'm about a week and a half into my intensive therapy program and I am feeling tired.  There are things I would like to write about but I've been kind of exhausted as of late and also haven't had that much time to just sit, reflect, and write.  However, hopefully I will have time for all that again soon...in between all the home visits, therapy sessions, and exposure homework.  It's going well, but I think that constantly feeling "off" and slightly anxious exhausts me more easily than I expected or am used to.  Just as I start to adjust and get comfortable, it's always time for my next session, time to climb the next stretch up the hierarchy of the many challenges ahead of me.

I'm still here.  Just spending more time than ever battling my OCD.  I'll keep chugging along and hope to have more time and energy to write here and comment on others' blogs soon!

Saturday, November 6, 2010

SHORT fuse

UGH. UGH. UGH.  I hate how OCD can lead me to rage almost instantaneously sometimes.  Of course that rage is misdirected.  I should be getting mad at the OCD, but instead I get mad at the person who unknowingly got between me and my compulsive avoidance. 

When I take out the trash, I avoid touching door handles.  Before getting the trash ready to go, I go downstairs and unlock and open the door so that I won't have to touch the door handle with my contaminated trash hands when I actually carry the garbage out of our house.  I did this as usual after doing my regimen of exposures that I have started attempting daily as part of my new intensive CBT program.  So downstairs I went, passing the girlfriend of one of my housemate's along the way.  As I passed her I thought, "She better not have closed the door!  I opened it for a very specific and deliberate reason..."

And of course, like most normal people would probably do when they see an open door, she closed it.  Cue the deluge of unwarranted profane name-calling in my head.  alksdjlfaksjdlkfasjdlkfjasd.  Yeah.  SO annoyed.

And you know what makes that annoyance worse??  Knowing that I have no real right to be mad at her.  She did nothing wrong.  She got in the way of my compulsive avoidance of touching a doorknob with my "dirty" hands by doing something responsible - closing a freaking door.  I have no reason to be mad.  And that infuriates me even more.  I know I should turn that anger around and use it against the OCD, but when my anger/anxiety shoots up like this, it takes all I've got to avoid going into complete compulsive mayhem.  If I can't be mad at her, I get mad at myself for being mad and start compulsively punishing myself through - you got it, compulsions.  It's harder for me to stop, to be rational, to keep the desire to wash and wash and wash reined in when I am irritated and angry.

I'll be okay.  Just really frustrated by the fact that I "had to" set down my bags of trash and go wash, knowing that I would "have to" pick those same trash bags up once again later, only to wash again.  I wish I could call what this girl did inconsiderate, but I can't.  Because in a normal world, what she did would actually be considerate.  It's just me in my bizarre world with my maladaptive rules that doesn't sync well with the rest of the world.  I'm working on it.  I've been doing well.  But sometimes there are these breaches in my relatively calm facade from which sudden, intense anger just bursts out.

Thursday, November 4, 2010

The Road to Recovery: Onward and Upward


Whew!!  Clearly I am not used to having daily commitments because I feel super busy keeping up with my daily therapy appointments.  OCD is used to having all the time it wants, just about anytime it wants, and that's beginning to change.  Sorry OCD, don't have as much flexibility in scheduling to allow my entire life to revolve around your whims...

I've been meaning to recap days #2, 3, and now #4, so here goes:

Day #2:  The Protective Shield of Novelty Begins to Wear Off

My second day of intense CBT treatment began with me waking up in a state of confusion, which I wrote about here.  The novelty and exhilaration of breaking all the rules had worn off considerably and I was left to face the reality of the consequences of my actions.   But I survived despite the fact that I felt really "off" and like I needed to somehow undo all the exposures that had taken place the day before.  I didn't do any "undoing" and I went on to get up and go about my day to the best of my ability.  Besides, I didn't have long to dwell on those feelings of unease because I had my second home visit later that afternoon, followed by my usual weekly group therapy session.  During this home visit I did the following, again, in my therapist's words:

  • touched pajamas to bathroom floor, then to bed
  • sat on bed
  • made commitment to wear previously-worn pajamas to bed tonight
  • 20 minute shower with alerts at 10, 5, and 2 minutes (went one minute over)
  • wore previously-worn jeans, put on barefoot
  • walked in room barefoot
  • dove into bed
  • dragged clean clothes along floor before putting away
  • walked barefoot on bed
  • put dirty laundry on bed
  • sat on bedroom floor
  • ate dried fruit with unwashed hands
  • poured water into a cup with unwashed hands and drank
  • washed hands for < 30 sec
  • touched handle of toothbrush, toothpaste tube, an dental floss container
  • touched shoe rack
  • touched garbage/recycling and disposed
Much of this was a repeat from the day before, which is good - that's what exposure and response prevention is about - repeating exposures and gradually habituating to them.  And I have to admit, it was a little easier, I think.  The hardest part was getting started.  I was really anxious about taking a 20 minute shower and was still feeling "off" from the exposures I had done the day before.  Aside from that, just being told to "take a 20 minute shower" felt daunting because I have a lot of showering compulsions that would have to be toned down or eliminated altogether to accomplish this (to give you some perspective...I have been regularly taking showers that have lasted right around an hour or more lately).  But as I have learned from the past - sometimes going to extremes (at least what I consider an extreme...lol) is easier in a way, than eliminating compulsions one by one.  Sometimes it's easier to just scrap it all at once, as best I can, instead of trying to eliminate each compulsion perfectly, before moving on to eliminate the next.  Instead of wading in to the cold water, sometimes it's easier to just jump right in, when you know you can handle it.  When you are determined to adjust.  And I was.  Don't get me wrong, I still have a lot of showering compulsions, but instead of allowing OCD to dictate how and when the compulsions could be eliminated, I tried to just do what my therapist was asking of me (for once) and just go for it.  If I didn't get to something or didn't get to wash something just right, so be it.  That was the point.

And now I have another 20 minute shower planned for tonight - but this one on my own, without someone calling out my remaining time and banging on my bathroom door to get me to stop.  I have to show myself that I can make myself stop, even on my own, as difficult as it is to make that choice without someone really pushing me.  I can do it - I even bought a water-proof shower clock so I could be sure to keep track of my time and really adhere to the limit.  I am committed to sticking to the 20 minute allotment, because if I get started taking a less-compulsive shower but then start letting it balloon out into extended ritualizing, it could get ugly.  No thanks.  20 minutes it is.  It seems so short to me that it's almost like it's not even meant to be a shower - and seeing it that way, like it is some sort of strange sequence of washing behaviors, makes it somewhat easier.  Instead of being a "poor" shower, it's like it's something different altogether that is not meant to be done in the same perfect way as my usual showers.


The other thing that was difficult was the very last item on my therapist's list there - taking out the garbage and not washing my hands until I got back from my group therapy.  I felt pretty dirty.  It's not the first time I've done this, but it's the first time in a long time that I've completed this exposure.  Needless to say I really wanted to wash before I proceeded to do my hair and put on make-up, but I didn't, and I even bought myself coffee before my group session - touching my coffee cup and various items in the coffee shop with my "dirty" hands.

Day #3:  More Exposure Plus New Therapist

The big challenge of day #3 was repeating the exposures I had done with my therapist present on Monday and Tuesday.  Now I had to do them on my own.  When my therapist has thrown out the words "oh, and you should repeat this as much as possible even when I'm not around."  I've usually thought, "um, yeah right."  But in the spirit of my new treatment regimen in which I attempt to push forward and do what my therapists ask of me, I thought I just might comply.  And guess what?  I did it!  Though it was nothing new (I had done these exposures twice already), doing it on my own, voluntarily was a big exposure for me!

Later that day, I had my first office session with the other therapist I will be working with as part of my treatment program.  I was a bit anxious about this (since I really like my "main" therapist), but as it turns out, I really like her.  She definitely knows what she is doing, and I had the chance to express some of the fears that are sometimes more difficult to bring up with my main therapist (like how I'm afraid I might be faking my OCD or somehow intentionally trying not to get better so that I can continue to hang out with my "main" therapist because he is just that awesome...).  I didn't realize how much guilt and fear I had been carrying around from these "what-ifs" until I admitted them to her.  I almost cried - and I almost never cry in therapy!  Talk about weird for me!!  Apparently I need therapy for my therapy, lol...We also did some exposure in the office with me touching my feet and then touching other things like my face and hair.  My hands literally smelled like feet!! (Gross!!!)

One thing I realized in sort of summarizing and explaining my fears to this new therapist was that a lot of the difficulty for me comes from simply making the decision to do an exposure.  It's infinitely more difficult for me, for example, to volunteer to touch my face and my hair, etc., after touching my feet, than having someone say, "Touch your feet!  Now, touch your face.  Do it."  It seems all the more wrong when I make the choice to break all my invisible OCD rules - rules that say things like "you can't touch this if you touch that," or "you have to wash if you do this or before you do that."  Don't get me wrong, I obsess about violating my arbitrary OCD rules even when I am explicitly directed to break them by a therapist.  But deciding to do an exposure without the explicit permission and direction from my therapist is that much harder, even if they are sitting right there, saying "Why don't we go ahead and do that, then?" once I suggest something that would bother me.

Inside OCD is calling me a traitor for giving up such valuable information, for so easily giving away the keys to its demise by volunteering battle strategies that might work well.  Obviously, we would get to these exposures eventually anyway.  But it's like I'm helping the enemy, feeding therapists the information that will speed its destruction.  Passively allowing the gradual destruction of my OCD is one thing, choosing to actually pick up a weapon and start attacking it is another.  OCD doesn't like that.  Not at all.  But it's what I have to try to do if I want to get better.  It's one thing to sort of let OCD fade away, it's another to show myself that I am capable of fighting it and winning.  I can choose to fight back and survive.

Day #4:  A Bit of a Break

And that brings me to today.  It's been an easier day.  I had another office visit, but with my usual therapist this time.  We repeated the foot exposure after which I went out into the world and spread my foot germs onto things that unwitting strangers were likely to touch.  Woo.  Sorry world, but you probably do way grosser things to me that I don't even know about.  Now you have a few of my foot cooties to go along with everything else :).  I haven't done much exposure other than that.  I have been putting off showering but plan on adhering to the 20 minute limit when I do.  And after that I may try to recreate some of the daily exposures I have been doing so as not to initiate a precedent of trying to weasel my way out of having to do them.

All in all, it's been a good week so far.  I feel like I am finally beginning to overcome the inertia that has held me back for so long.  I am finally beginning to gain real momentum in moving forward in my fight against OCD.  I think two of the most helpful things have been mindfulness and the ability to just sort of see this next month as a time of perpetually feeling "off."  Instead trying to make things feel "right," I am just trying to accept that I will probably feel somewhat strange a lot of the time while I am in intensive treatment.  With that in mind, I try to pretend like this is just some sort of completely different universe - one where my former rules no longer apply, one with strange customs like taking only 20 minute showers and walking on my bed with bare feet.  Shocking I know.  What sort of people would live in such a world?  ;)  But if I'm going to get better, I have to get used to living in this world for a while, and eventually it just might feel like my own again.

I may stop writing about each and every day, since I am already having a hard time keeping up and because it is bound to get redundant, if it hasn't already.  We'll see!

Tuesday, November 2, 2010

Conundrum

This morning, I woke up not knowing how to proceed.  I was overwhelmed by the feeling of being "off," of not knowing exactly how I had violated all my rules and how to compulsively solve them.  Normally my solution to this problem is to mentally and physically wipe the slate clean by taking a shower and washing whatever I am wearing.  In my mind, showering washes away whatever OCD transgressions I committed so that I don't have to sit there in vain, trying to remember each an every one.  I can let go if I can just shower, and condemn whatever I am wearing to the dirty laundry.  It's my mental restart button, and it seems to reset my life and my ability to discern what is clean v. dirty.

Once I am myself "clean" it is easier to think clearly and start fresh.  I feel like the world has been returned to its "right" state at that point.  I feel like "myself" once I have performed these compulsions and I feel "clean enough" to go about fixing the other problems I see around me, instead of making them worse by potentially "contaminating" them in my possibly "unclean" state. 

But I am not supposed to shower until my home session later today.  And during that shower I will most certainly not be permitted to shower "correctly" or in a way that would set me feeling "right."  And that's fine.  I can deal.  I just have to remember that I am not trying to recreate the world I was living in before.  I'm not trying to constantly pull myself back into that "safe" life by making things feel okay through compulsions.  Instead I'm waiting for the feeling of chaos to settle so that I can get past this, resisting solving my "problems" the compulsive way in the meantime.  My world will return to feeling "right" on its own if I let it.  I just have to wait it out. 

Like I said, the goal of all this is not to cling to and preserve my world as it was before.  The point is to move beyond that world, that life, and realize that things will eventually feel alright again without compulsively returning them to the OCD-defined "correct" state.  I was determined to jump in with both feet and not look back once this process began.  This is my chance to do just that.  The exposure has been done.  Now it's time for some thorough response prevention.  OCD is yelling at me to turn around and run back the other way, but this time I decided that once I got started, there was no turning back.  This is my chance to set myself free, and I'm determined to take it.

Monday, November 1, 2010

Day #1: Giving Myself Permission


Well, it's that time.  Operation "Destroy My One and Only Pristine Sanctuary of Cleanliness in this Dirty, Dirty World" is well underway (go here for further explanation).  Here's a recap of day one, in my therapist's words:

  • Touched bed with unwashed hands
  • Stripped bed, put bedding on floor, then remade bed
  • Dumped dirty laundry on bed
  • Removed bedding from bay window and placed on bed
  • Confiscated sanitizers and bag of hoarded receipts
  • Sat on floor
  • Briefly touched toilet seat and handle, then returned to bedroom
  • Touched items in "condemned corner"
  • Walked on bed in bare feet
  • Touched clean clothes with unwashed hands, touched clean clothes to dirty clothes, touched clean clothes to floor and put away with other clean clothes
  • Ate dried fruit with unwashed hands
  • Touched flute with unwashed hands (esp difficult)
  • Touched all areas of bedroom in no particular order with unclean hands
  • Touched doorknobs and light switches
  • < 30-second hand wash
Doesn't that sound like fun?  Oddly enough it kind of was.  I felt kind of like a kid sneaking around, stealthily going behind OCD's back and messing things up without its permission.  It's liberating in the moment - until OCD sees the crimes that  have been committed and gets angry.  But so far I have kept that wrath in check.  I'm doing my best to jump in with both feet.  I've spent a year taking it slow, gotten a lot better, but still have quite a bit of work to do.  As my therapist said, now it's time to bring out the big guns.  And well, I don't want to have to rip apart my current life to seek what would probably be the next level of treatment - residential - so if I'm going to go for it, now's the time.  Bring it!!

One of my fears about doing exposures is that I won't feel the "right" way about it.  I'm not bawling my eyes out.  I'm not shaking with fear.  Does that mean I don't have OCD?  That's what I'm afraid of.  But I think one thing that I have learned just today is that everyone reacts differently to the challenges presented by OCD.  I have spent my fair share of time bowing down to its relentless demands, obsequiously obeying its random whims.  What I'm realizing is:  I don't have to compare my reactions to OCD and its treatment to that of others.  I don't have to figure out how I "should" be responding to be sure that I actually have this disorder.  There isn't one "right" way to react to OCD and there isn't one "right" way to respond to its gradual elimination through ERP.

So I'm slowly getting used to the idea of giving myself permission to do the things I am supposed to be doing in treatment if I think I can.  Up to this point, it has often been very difficult for me to comply with my therapist's instructions.  OCD would come up with loopholes, exceptions, endless reasons why it was unacceptable to do my homework; it would demand absolute certainty that doing this or that exposure was exactly what my therapist had intended and nothing more.  This often meant that I would agree to do what my therapist asked me to when he was around, but as soon as I started facing things on my own, the insidious questioning of OCD began:

"Wait, he didn't specifically mention this situation, did he?  This is different.  You can't do that exposure now.  He may not have anticipated this exact scenario, therefore, the exposure is off.  You have to wash.  You can't take that chance."

And soon one exception becomes two, and two becomes three, and by the end of the week I've given up on the exposure altogether because there are no longer any "acceptable" situations in which to actually do it.  Then I go back to therapy and mention all the problem situations I encountered, get reminded once again that I should be taking the risk of doing the exposure in the wrong way, at the wrong time, in the wrong situation, and feel renewed determination to do my exposures no matter what - at least until the next questionable situation arises and the process begins again.  If I want to really get better, I am going to have to give myself permission to go for it - to take the chance that I might be going above and beyond the bare minimum that my therapist asks of me (or more realistically, I'll have to actually take the chance of successfully completing the bare minimum...).  If being able to take that chance somehow proves that I don't have OCD, that I am a fraud, that I have for some self-serving reason made this all up, as I so often fear it will, so be it.  Hope no one minds if I continue to blog about the treatment of my potentially fake OCD. ;)

So what am I feeling in the aftermath of day #1 of Operation Destroy My Pristine World of Cleanliness?  Well, mostly I'm just tired.  Processing all that has happened takes a toll on my brain, I think.  Never really feeling quite "right," like I can definitively put my mind at rest and relax in the illusion of "knowing" that certain things are either clean or dirty, however short-lived that knowing is, can be draining.  (Then again, only getting four to five hours of sleep can also do the trick...). 

Things feel kind of chaotic and all over the place right now, but I have committed to not undoing what's already been done.  I'm sick of OCD, and this is my chance to really get some momentum going in fighting back.  The things that are now "dirty" will remain "dirty" and will be treated however I would normally treat them.  No avoidance, no compulsive attempts to fix the "damage" that's been done.  And that in itself is a great burden lifted.  Giving myself permission NOT to sabotage my treatment is a relief in and of itself.  The feeling that I have a "responsibility" to resist my therapist's recommendations may return as I continue forward, but I plan on doing my best to keep going despite it.  This is my chance to finally break free, to allow myself to engage in treatment as I know I am capable of doing.  So, like I said - just doing the best I can to jump in with both feet so that I can run forward without looking back.  It may temporarily feel like I am living in some strange alternate universe, but eventually it just might feel like "home" again. 

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