Life with OCD


Everyone’s this way a little bit.
It’s adaptative to check the door two or three times to be sure it’s locked.
It’s not adaptative to check it fifty times.

I have Obsessive-Compulsive Disorder (OCD).

I talked some about its physiological basis, and treatment, in a previous post.

I will tell more, and about my own experience, now.

How it works

One’s senses constantly send one’s brain untold jillions of bits of information.  One’s eyes alone send billions, ten times every second.  There’s no way one can possibly process it all.  Something somehow must filter out what information to notice or pay attention to, and what information to ignore.

This is one of several tasks of the caudate nucleus, a portion of the brain located just behind the top of your noise.  If you put your finger just at the top of your nose, the caudate nucleus is just behind there.

In people who have the same form of this disease as I do, when one shifts one’s attention from one thing or one task to another — as, for example, in leaving home for work in the morning — the caudate nucleus fails, stops working, throws up its arms and says, “I quit.”  Instead of letting some information through, it lets it all through, and the brain is  flooded, overwhelmed with information.

The patient’s conscious awareness is then overwhelmed also, and one is left scrambling anxiously to find some way or some thing on which to get a grip; a doorknob, for example.

Onset

Symptoms commonly appear in late adolescence.  So it was with me.  Fall semester of my senior year in high school, I developed the pattern of coming to feel — just as I was about to go out the door to school — that I needed to check the stove to make sure it was off, even if I knew full well that it had never been on.  I will describe the checking in more detail below.

I don’t recall how much time that took each day, but I recall my homeroom teacher telling me that I’d been late for school fifty times so far that semester.  Despite my living literally right across the street from the school.

Symptoms disappeared while I was in college, but came back after.

A typical morning

For the moment, I’ll focus only on what happened at the door.  I’ll tell about other things I used to check below.

Here I am, outside my apartment door, with all my wraps on, all the things I need to carry in my arms, and it’s time to close and lock the door and leave for work.  And I do, and turn to go, and now the turmoil comes.

Memory is indexed affectively, that is, according to one’s feelings.  A sudden change in how one feels can wipe out, for that moment, the memory of what one has just done.  Or, at the very least, and this is the deal with this disease, wipe out one’s confidence in that memory.

So now it was.  I’d lock the door and check it — and then have no memory of having done so.  Did I really do it?  Can I trust the memory that I did?  Better do it again.

Knowing that I would not trust the memories of the first five or dozen times I did it, one strategy some patients use is to pick, as it were, magic numbers.  I will check the door 39 times, or 47, or 75.  I will count the times I check it, and when I reach that number, I can be sure, and remember, that I checked it that many times.

A conversation with a co-worker

I made an offhand comment about my OCD, and she said she has it, too.  This surprised me, as we are completely different people, and I actually dislike her.  But her story fit my own.  She named three things her anxiety tended to focus on:

  • Anything involving fire
  • Anything electrical.
  • A compulsion to touch things.

As to fire, the stove is an obvious example.  Also candles.  Also cigarette butts.  I remember pinching every butt in the ash tray to be sure it was cold — and then pouring water into it to guarantee they couldn’t reignite.  Just tossing them in the toilet bowl was not an option, lest there be some live ash to fly out to places I’d not see, and start a fire after I was gone.

Electrical things are a logical extension of the fire issue; since they can spark.  Light switches and plugs.  I didn’t, but she said she did, go around the house and make sure every single device (except the fridge) was unplugged.

It was never enough to see that the stove knobs were off, the light switch was off; I needed to touch them, feel them, press them again in the “off” direction; but that itself was often not enough.  What if, in doing that, I had inadvertently turned them back on?  Well, one option, sometimes, was to turn the thing back on, and then turn it off again; and then, I thought, I could be sure.  But this typically just landed me in the same place I’d started from, and I wasn’t sure.

In one session with a therapist, I expressed a terror that under certain circumstances I might inadvertently harm someone.  She said this phobia is common among OCD patients.  I can see how this might translate into a reluctance to own power or become prominent or accept positions of authority.

Loss of depth perception

Circa 1980, I became aware that in extreme episodes, I was likely to lose depth perception.  In the emotional turmoil, I never pinned down whether I was seeing out of one eye or the other; I only knew that “the world went flat.”  This has several ramifications.

First, I normally wasn’t aware that it had happened; only, I’d look around the room and say, “Something doesn’t look right.”  Of course things didn’t look right, under these conditions.  But I’d often wind up walking around the room trying to find out what was wrong.

Second, there was a directly analogous disturbance of my thought processes, that might affect me anytime during the day.  Just as, in a “flat” visual world, it becomes impossible to tell what is near, what is far, what is large and what is small; so also, in decision-making and seeking to order my activities, I have often had conflict in discerning what’s most important (big or small) or most urgent (near or far).  This can make indecisiveness much worse.

Feelings

I have no eagerness now to recall or tell all the feelings I went through in these episodes.

We begin with the anxiety itself.

Then came frustration with my inability to cut off the repetitive behaviors.

Then came guilt and shame at the absolute certainty that I’d be late to work — again.

And, wholly reasonably under these circumstances, self-loathing.

The emotional pain often enough became physical, as I’d tense up certain muscles in my chest until they actually hurt.  I came to call this state “agony.”  Wholly consistent with the ways of this disease: just as, in order to get a grip, I would grasp the door handle so tightly that it hurt; so also, I came sometimes to use this chest pain as my grip, my handle, my mooring.  And boy, did it ever hurt.

All this gave me two important learnings:

(1) Feelings come first; they occur first; ideas come after.  I became anxious first, and then always, without fail found something to be anxious about.

(2) Feelings do not always have a rational basis.  They’re not always right.  I had success when, standing outside my apartment door, I would completely step away from my feelings and head down the stairs.

Apparently it never occurred to me to question God as to why all this was happening, or why I had been built this way.  Of course, I did not know I had been built this way, until a psychiatrist, prior to medicating me, explained to me the genetic and physiological bases of the disease.  Until that point, a value judgment: I thought it was all my fault.

SSRIs completely changed my life.

I need say no more.

Today

… I have only two notable symptoms.

One involves my meds.  I take five pills every morning, a different four pills every night, and two other pills twice a day.  I will count them three or four times to be sure I have them all, and all the right ones.

The other involves excessive use of toilet paper.

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