It’s mental health awareness week, and in that spirit I think it’s time I talked a little bit about OCD.
I was diagnosed with Obsessive-Compulsive Disorder last year, after struggling for some time with increasing anxiety, a spate of panic attacks and somewhat bizarre behaviour tics I’d developed to cope with these things. I didn’t believe I had OCD to begin with: I’ve never been obsessive about germs and hygiene (I work in a lab handling bodily fluids!) I don’t wash my hands a hundred times a day, and I don’t exhibit any unusual ‘checking’ behaviours – returning multiple times to check that the front door is locked, for example, or opening & closing the car door three times before feeling safe enough to drive.
But I do have OCD. The form I have is lesser-known, and rarely depicted when discussing or showing characters with the disorder. OCD UK lists the different subtypes – The ‘Checking’ and ‘Contamination’ types are what we typically think of when someone mentions OCD, the ‘classic’ model of the disorder, and quite possibly the most common – or at least, the most commonly diagnosed.
I have what is known as ‘magical thinking OCD’, which is described by OCD UK:
….is the fear is that even thinking about something bad will make it more likely to happen – sometimes also called ‘thought-action fusion’. Sufferers are beset by intrusive bad thoughts. They try to dispel them by performing rituals – magic rituals, in effect – that are often bizarre and time-consuming and involve linking actions or events that could not possibly be related to each other.
Before I talk about some of the rituals, I want to go back in time for a moment. Back to 9-year-old me, and when my mental health problems first made themselves known. At that time my parents were divorcing – a fairly traumatic experience for any child. I was staying at my dad’s, and I picked up a ‘bizarre science’ type magazine he had lying around (I was a very precocious reader, which was not always an advantage…)
In this magazine was an article about the Ebola virus, which, in 1995, was still on the fringes of Western consciousness – not as it is today, following the horrific outbreak in West Africa a few years ago. I can actually recall entire paragraphs from this article – it was quite graphic, especially for a nine-year-old, written almost as a fictional narrative but ostensibly about a real-life individual who flew to Africa, encountered a man dying (horribly) of Ebola, and returned home incubating the disease. Of course, he too died horribly.
The article didn’t scare me at the time. But afterwards, I couldn’t stop thinking about it. And at that point the floodgates opened. I suffered debilitating panic attacks at the thought that my family might die suddenly. (Not necessarily of Ebola, I might add, but I think the knowledge that such terrible illnesses were out there, waiting to metaphorically pounce was an awful lot for a 9-year-old brain to deal with.) Things escalated, and eventually I was seen by a child psychologist. I don’t recall an awful lot about that except that she commented several times on how active my imagination was.
(And, well…some things never change, do they?)
Back to the present. I learned to tolerate anxiety as you might a small, annoying child in the back seat of the car screaming “you’re going to crash and kill everyone!” at intermittent moments. But OCD sort of creeps up on you. You don’t really comprehend how weird your behaviour is becoming until you’ve accumulated enough rituals that your day-to-day existence starts to revolve around them. And they are bizarre. For example, I began to avoid specific pieces of clothing that I had been wearing when I felt unwell. I could not change any of my jewellery, because a small voice in my brain suggested that to change them would be to invite terrible possibilities – my husband would die, for example (this is my brain’s favourite potentiality.) I could not step on three drain covers in a row, because if I did, by the time I got home/to work something awful would have happened, and it would be my fault. (That led to several collisions as I swerved to avoid the drains on the street. Try explaining that to the miffed bloke whose coffee you just knocked out of his hands.)
The inflated sense of responsibility in OCD is crippling. You are fully aware that what your brain is telling you – screaming at you, really, because it is like a foghorn in your ear at full blast – is a pile of horseshit. It can’t possibly have any bearing on the Real World. How can changing my earrings cause my husband to contract meningitis? How can stepping on three drains cause me to be fired? And yet the act of removing my trusty old earrings would cause such a spike in my heart rate that I couldn’t do it, any more than I could walk out into traffic. It was a dangerous act. You are responsible, somehow, in some nebulous way, for all the bad things that might possibly happen – and when a bad thing does happen, you connect the dots to some innocuous activity or thought you might have had. Wham: a new ritual is born.
(As a quick aside, I only developed two writing-related rituals, both of which I am yet to shed: I never include the title in a manuscript or file name until the piece is finished – because to do so will mean I’ll be unable to finish it. And I never admit out loud if I think a finished piece is good or that I’m proud of it – because to do so will mean that nobody will ever publish it. Some habits die harder than others.)
My therapist liked to say that OCD lies to you, and that’s accurate. You start off indulging these rituals because they’re relief in the short term, and they make you believe you have control over all the things that wake you up in the middle of the night – is my husband still breathing, are my cats alive, is the house on fire, am I dying – but the truth is, you don’t. You never do. And the rituals by their very nature become consuming, because they prove themselves wrong: bad things continue to happen no matter how strictly you adhere. So you create more rituals, until your entire life is a catalogue of things you can’t do, and things you have to do ‘just so’. It’s bonkers, and you’re entirely aware even as you’re studiously avoiding drains and wearing the same shabby earrings for three years on the trot that you’re being irrational. But you can’t stop.
In the end, it was a kind of exposure therapy which helped me shed – or at least control – most of the weird rituals. My therapist challenged me to do the things my brain expressly dictated were verboten, starting small – wearing the t-shirt I wore the last time I was ill – and building up to the most fear-inducing. At the same time, we worked at deconstructing the misconceptions I had been wilfully labouring under for so long: I am not responsible for keeping everyone around me safe. Intrusive thoughts are not real, and could not hurt me – thinking ‘my tattoo might go septic’ is not enough to actually make that outcome happen. The world is a strange and utterly random place, and the unknown is scary, but it can also be wonderful and exciting, and it’s okay to not be in control all the time.
And I learned other things, too. Anxiety is my brain’s way of protecting me, even if it’s misguided in its application, so I should try to be tolerant of it. Panic attacks are unpleasant, but they can’t really hurt you, and they don’t last forever. The worst case scenario is usually highly unlikely, but even if it does happen, the world doesn’t fall to pieces. You can cope.
It’s hard to accept sometimes that you’re never really ‘cured’ of any mental disorder – you learn to cope and to control it, but it never really goes away, and sometimes it’ll spike just when you think you might never see it again. And though I’m more in control than I’ve ever been, I still struggle – mostly with anxiety (especially in social situations, and worse, when travelling abroad – which happens to be one of my favourite things to do). It’s a process, I keep reminding myself, and a slip now and again is not the same thing as defeat.
It strikes me as ironic sometimes that the same mechanisms which cause the delusions, paranoia and catastrophising that make up OCD also give me the ability to create new worlds, and people to populate them; the part of me that creates terror at entirely imagined situations and weaves causality out of thin air also creates strange creatures, purple-tinted prose and weird plots. My ability to write – and to write about fear and terror specifically – seems inextricably linked with the malfunctioning parts of my brain. And if that’s the trade-off, is it so terrible? I sometimes wonder if being drawn to horror is a more unconscious process than I first imagined – if, perhaps, it’s a coping mechanism of sorts, a way for my brain to spill out all its fears and invented situations in a controlled (or semi-controlled) fashion. Perhaps writing horror is healthier than I’d been led to believe…?
(And look! After three years of irrational panic, I’ve finally been able to change my earrings as often as I choose:)