I have been in touch with the Obsessive Compulsive Disorder (OCD) for many years and for different reasons related to my personal life. I have observed at very close quarters its varied symptoms, its tough effects, and the deep feeling of frustration and helplessness that travels along with the patients and their relatives in this difficult trip. I have had the chance of reading and researching very much about it, with a mixture of perplexity at the complexity of human nature and thankfulness for the passion and talent of many wonderful professionals all over the world. I have likewise felt bewildered at the lack of interest, understanding, support and commitment of both the authorities and society in general regarding the approach to mental illness in all its facets. And, all in all, I have had the chance of drawing my own conclusions concerning the whole sphere of activity of this particular illness.
I am not a healthcare professional, nor do I mean to irresponsibly replace any kind of professional support and guidance in the complex treatment of the OCD. But one extremely important aspect in the fight against mental illness is the modest contribution each of us can provide, in any field, in order to make this fight much more efficient. And this is perfectly complementary with medical treatment and scientific research. I will thus try to provide my personal vision of different aspects directly linked to the OCD, with the very humble illusion that it might be useful for someone at some point in time.
Let’s then start by pointing out that the first serious symptoms of the OCD usually arise in adolescence, most unexpectedly and striking hard. The patient suddenly finds himself submitted, not only to the undermining discomfort and the crippling nature of those symptoms, but also to the disorientation of ignoring how to handle in every respect such a challenging new scenario. There is also a feeling of shame, a kind of “how could I possibly speak about something so humiliating and extravagant with anyone?”.
This first stage of the illness is specially harsh. The fact that it usually takes places in adolescence also contributes to rapidly expand its effects, as we all know that this period of life is characterized by a clear inclination towards insecurity, even in non-pathological cases. So this is usually the beginning of a relatively long period of time in which the patient is faced to a daily frightful struggle, completely devoid of the basic means to confront it: understanding of the family, correct diagnosis, information about the illness, accurate treatment…
A much more optimistic and productive stage will start when the patient and his family achieve a better knowledge of the various fields of action of the illness. Let’s not forget that, unlike other psychic pathologies, the OCD sufferer is from the very beginning conscious of the existence of the illness and yearns for its overcoming. In this regard, it turns out fundamental to provide the patient with every possible means of communication to successfully convey his real condition to his closest relatives (usually his parents). Once this preliminary objective achieved, the path becomes automatically clearer.
In the process of understanding the illness, it is important to note that both the biological and the environmental side seem to have an influence. Anyhow, in accordance with my preliminary comments, I will just focus on the most remarkable features of the illness that I have observed in my personal experience as for symptoms and effective treatment tools. This will therefore be an eminently practical and subjective approach to some key aspects closely related to the OCD.
Among the different types and varieties of OCD, there is basically one core symptom: the feeling of being subdued to an irresistible force that leads the sufferer to perform all kinds of extravagant actions and behaviours. Despite being fully aware of the absurdity of his actions, the sufferer finds it impossible to stop falling into that permanent trap as the only possible way to try to get some relief for the dreadful level of anxiety regularly achieved in the course of his illness. However, those repetitive rituals only lead to a superficial relief and they conform, in the long run, a tangle which sinks the patient deeper into the illness.
It turns out then fundamental for the sufferer to take advantage of his moments of lucidity to carefully analyse the action process of his illness, in an objective, distant and strictly factual manner. A very useful tool in this respect is to take one recent symptomatic episode and scrutinize it from two different perspectives:
- The actual behaviour of the patient during the episode.
- What a healthy behaviour would have been in similar circumstances.
The easiest way to go through this will be to provide an indicative example. Let’s then imagine a patient who has to leave home to go to work. Something perfectly daily and common, isn’t it? All the same, our patient cannot perform this very simple act without undergoing an extraordinary anxiety level. Did I turn off all the taps? Did I shut the window? Were all the cooking ranges off? Did I lock the main door?… His departure from home will definitely be delayed and, once out of home, he will probably be compelled to return and double-check it all again. Besides, once definitely on his way to work, he will keep mulling it all over for a long time, and he will only be relieved from this particular thought when it gets replaced by another obsessive intrusion that may automatically arise. In any case, this original obsessive thought (related to the verifications prior to leaving his home) will keep coming and going for hours.
Now let’s imagine that the day after this particular event our patient does not have to go to work. He is at home in relative peace, and decides to make use of the situation to put into practice the afore-mentioned tool. He will consequently start analysing what his actual behaviour has been with regard to his problematic home departure, writing down at the same time the most relevant facts and conclusions:
It all started suddenly and unexpectedly. He was at home getting ready to head out and, although he was feeling slightly restless, everything was going quite smoothly. He had almost finished dressing up when, all at once, a terrifying thought came to his mind: What would happen if he left home without having everything in perfect order? Maybe a catastrophic event could take place. This thought brought about an automatic feeling of terrifying anxiety that completely blocked him: he remained motionless for a couple of minutes, put his face down around his arms violently shaking up his head, felt his blood pressure rocketing, his head seemed about to explode… There it was once more: the tyrant who seemed to live inside of him performing his tireless punishment. Automatically, he felt compelled to ritually carry out the only way of escape that could provide him a temporary and slight relief: checking up the taps, the windows, the cooking ranges and so forth.
In short, our patient is observing -in detail and at a distance- a very illustrative example of how his OCD generically works. He can see that right before this obsessive episode burst out, he was somewhat waiting for it to happen, as he has deeply engraved in his mind that it is impossible to live without successively jumping from one obsessive episode to another, thus providing an extraordinary breeding ground for the whole obsessive-compulsive process.
He can likewise see that most of the people he knows would have never found anything menacing in a situation that is objectively fully normal: getting ready to leave home in the morning. He can also see that the deep reason for his alarmed reaction is exclusively linked to a permanently wrong processing in the analysis of reality, and not to the actual facts that were taking place. He can see as well that this inaccurate processing directly leads to a full loss-of-control status: indescribable anxiety level and subsequent extravagant reactions clumsily seeking relief.
This preliminary phase of analysing the facts, important as it is, is just the first step. The toughest part comes right after: Our sufferer has to assimilate that the key points in the cognitive-behavioural treatment of his illness are relatively simple to enunciate, but require an extraordinary long-term effort in their successful application. The quest for success in the treatment is undeniably based on accepting that the process is going to be painful, full of relapses and ups-and-downs, and with no end date.
I will next list what I consider to be, in my experience, the key points in the necessary mental attitude of a patient to defeat the OCD:
- My illness is the result of a biochemical imbalance and an incorrect pattern in the interpretation of reality, which has settled down over the years.
- I don’t have to waste a single second of my time complaining about my disorder. This is a problem that I have, I assume it and I am ready to face it.
- Every obsessive-intrusive thought is an enemy knocking at my door. I don’t have to fight it. I just have to distance myself from it taking the role of a neutral observer. It is just a question of time for that thought to vanish.
- Every obsessive-intrusive thought knocking at my door is not a catastrophe, it is actually a challenge.
- Whenever a thought causes me an unjustified level of anxiety, I am conscious that thousands of people would never feel worried or anxious about such a thing. If they can, so can I. It is just a question of time.
- Whenever I feel compelled to perform any kind of ritual in order to lower the anxiety level resulting from an obsession, it is fundamental not to succumb to it. The anxiety level will probably rise, but sooner or later it will disappear. This procedure is fundamental to break off the repetitive obsessive-compulsive circle in all its forms.
- My mind tends to daydream and focus in small details. I have to permanently seek the contact with reality and a broader and more general focus of it.
- My real aim is not to wake up one morning proclaiming that my illness is over. My task consists in an everyday work aiming at feeling fine with myself, conscious that absolute perfection and complete happiness don’t exist for anyone.
I remember having read once, in the book by Edna B. Foa and Reid Wilson “How to overcome your obsessions and compulsions”, something like: “If you, as a sufferer, feel absolutely terrified about simply just getting up from bed but you are eventually capable of doing it, don’t downplay the fact: you have achieved something formidable”.
I think that example pretty much summarizes the most important of all: Never forget that your merits are directly proportional to your existent constraints, and never give up.