Therapy Success Stories
Graduate OCD Sufferers Speak Out
Graduate Story #12: Game Changer
For forty-four years I lived with a severe case of Obsessive Compulsive Disorder (OCD). I suffered both from compulsions (feeling compelled to repeatedly perform specific behavioral rituals) and obsessions (becoming fixated upon certain irrational thoughts or mental processes). I saw therapists and specialists across the country, and although some were able to help me with my compulsions, it seemed that no one really knew how to treat the purely obsessive components of my disorder. Then, almost by accident, I found a psychologist who showed me how to fundamentally change the way I related to the disorder, such that now I can go through my day and do what I need to do unimpeded by my OCD.
I was once told that on a scale of one to ten, my OCD was a ten in severity. It emerged suddenly when I was eight and soon differentiated itself into many of the most common forms of the disorder. I developed compulsions related to counting, symmetry, contamination, washing, scrupulosity, and even prayer. For example, I had a counting ritual, the rules of which were that when I touched something, I had to do it in sequences of three. A particularly humiliating ritual was my compulsion to confess thoughts about which I was ashamed to others. I also felt compelled to retrace “bad” thoughts in my mind so that I could “re-think” them without the offending components.
When I reached adolescence, the disorder’s intrusion into my life grew exponentially, affecting me in countless new and terrifying ways. It virtually crippled my ability to study. Reading became nearly impossible, because if I didn’t read each sentence over and over again, I would be seized by the feeling that something was terribly wrong. And when I actually was able to complete a homework assignment, the conviction that I had “cheated” in some way would grow until I ripped the assignment up and threw it away. I also felt compelled to do and say things in front of others that they found strange, causing confusion and hostility and leaving me isolated from my peers. For example, in school, right after dismissal, when kids were still milling around in the classroom, I would walk backwards between each row of desks, reading a textbook aloud in a soft voice.
Then, with the help of a wonderful therapist, several doctors, and even a Catholic priest, I was able to “contain” the disorder. It wasn’t gone, but for a time, I managed to keep it at bay. I became much more functional and was able to take advantage of the opportunities that life presented to me. By the time I reached adulthood, I had a job I loved and had made a lot of money from some smart investments. I lived in a beautiful home filled with fine furniture and art and drove a high-performance sports car. I took lavish vacations, staying at some of the best hotels and dining at some of the finest restaurants in the country. Everything about my life seemed great, except that my OCD still remained, and slowly but surely it consumed more and more of my time and attention until I no longer could take any joy in all of the wonderful things in my life.
The progression of my illness culminated about twenty years ago in an obsession, the theme of which was that by trying to recapture a particular feeling that I had experienced most intensely when traveling, I might at one point have taken a trip that I didn’t really need to take, and if that was the case, then all of the subsequent events of my life had been changed from what should have been to something else, something illegitimate, and my life had been ruined. At first, this obsession bothered me only intermittently, but then, about three years ago, it worsened dramatically until it became the central focus of my disorder – and my life. The extraordinary pain and sense of desolation I felt as a result of this obsession were far worse than anything I had yet experienced from my OCD.
No one seemed to know how to treat this obsession – not the therapist I had seen for twenty-five years or the wonderful psychiatrist I was seeing at the time. I went from one specialist to another to no avail. I tried just about every drug and every combination of drugs prescribed for OCD, but nothing worked.
Over time, my increasing rumination made it more and more difficult to function. I stopped opening my mail, and I answered my phone only when one of the utility companies for my house called to threaten to cut off service if I didn’t pay them what I owed. I went for days without logging on to my computer and checking my email. I stopped cleaning my lovely home and taking care of my beautifully landscaped yard. I no longer invited friends over – in part because I didn’t want anyone to see what a mess my house had become, and partly because I simply felt so miserable that I didn’t want to see anyone. Although I managed to continue to work, I did only the bare minimum necessary to avoid getting fired, and when I got home, all I wanted to do was get into bed and sleep until I had to get up for work the next morning. I had always been very proud of my investment skills and had taken an active role in managing my portfolio with my broker, but even in that area of my life I became dysfunctional, and I stopped monitoring my investments and communicating with my broker. I just didn’t care anymore. Then, after forgetting to renew my auto insurance, I got into a serious accident and wrecked the car I loved so much. I also was injured in the crash, and my recovery took weeks – longer, in fact, than it should have because being injured gave me an excuse for just lying in bed and doing nothing day and night.
One night, in desperation, I Googled the words “pure obsession” on my computer and found the website of the psychologist, Dr. Steven Phillipson. As I read through the material on his site, much of it seemed to relate to what I was experiencing. His office was in Manhattan, however – about two thousand miles from where I lived – but on his website, it said that he sometimes conducted consultations via Skype, so I called his office and spoke to his assistant. It turned out that there was a six-month waiting list for those who were interested in working with him, but his assistant told me that when he had a cancellation, he sometimes would do a consultation with a prospective patient, so I gave her my name and number. A few weeks later, she called to say that Dr. Phillipson had an opening for a consultation. I leapt at the opportunity.
At the consultation, I tried to explain the obsession that had become such a nightmare for me, and I told him that no one had been able to help me overcome it. Even the wonderful therapist with whom I had worked for so many years, and who had helped me so much with other aspects of my OCD, was unable to do anything. Dr. Phillipson’s response was surprising. Unlike all the other therapists I had seen, he didn’t seem perplexed or worried – or even particularly concerned – about me, and when I finished, he casually informed me that he had treated some fifteen other patients with obsessions like mine. He even had a name for the type of obsession from which I suffered; he called it “The Altered Destiny Obsession.”
Dr. Phillipson then proceeded to educate me about what happens in the brain when an individual experiences an obsession. He used the analogy of someone who cannot remember the name of the actor who starred in the movie “What About Bob” to illustrate how the process works. As hard as the person tries, he cannot recall the name. Eventually, he gives up and goes about his business. Then, suddenly, in the middle of some unrelated activity, when it seems he is not thinking about the movie at all, the name Richard Dreyfus pops into his head. He had been unaware that his brain was still working on the problem. Dr. Phillipson said that this shows how the brain functions. It continues to work on a problem in the background even when you seemingly have turned your attention to something else. He said that with an obsession, the brain is always working on the issue, trying to solve or resolve it, and since there is no definitive answer to the question, the process goes on indefinitely.
“Can you help me? Will you treat me?” I asked.
He didn’t answer right away. Then, a moment later, he said, “Yeah, I’ll treat you.” I don’t know why he paused. Perhaps he was trying to determine if I was the kind of patient who seemed likely to adhere to the protocols of the therapy. It certainly wasn’t that he had any doubts about whether he could treat me successfully. It was more like he knew exactly what steps I needed to take to get better, and the only real question was whether or not I would follow these steps consistently to recovery.
In referring to the OCD, Steve used two terms with which I was not familiar: “spike” and “ruminate.” When he explained what “spikes” were, I realized that these were what I experienced when, as I put it, “it hit me” and I got that sudden, very powerful feeling that something was terribly wrong. My body would tense up, I would break into a sweat, my heart would start racing, and I would get sick to my stomach. Similarly, I realized that “ruminating” was what I was did when I was trying to “think about it or figure it out” – that is, to figure out why I felt so awful after “it hit me.”
Several months after our consultation, I was informed that Dr. Phillipson had an opening for me. My appointments would be on Thursdays at 8:00 A.M., New York time, which was 6:00 A.M. in my time zone, but without a moment’s hesitation, I agreed to this arrangement.
At our first session, Dr. Phillipson instructed me to record each session and to listen to the recording before our next appointment. He also said he preferred to be called Steven. Over the course of the first three sessions, he took a kind of history of my disorder, asking lots of incisive questions. Then, towards the end of the third session, he turned to me and said, “Yeah, you’re right. Your obsession is true. Your life is ruined. Your life is so ruined that I want you to get some 3 x 5 cards, put “How My Life Is Ruined’ at the top of three of them, and write down one of the ways your life has been ruined on each card.” He told me that I should read one of these cards every half hour, rate the intensity of the spike and the urge to ruminate on a scale of one to ten, and write that down on the card as well. He told me to carry these cards with me wherever I went and to leave them at my bedside at night. He said that reading one of these cards should be the first thing I do when I wake up in the morning and the last thing I do before I go to sleep at night. I did as he asked and wrote down the following spikes, one on each card:
You sought out that feeling, and it altered your life and ruined it.
2. Your entire life is tainted because you sought out that feeling. You can never experience joy again.
3. You would never have those beautiful paintings if you hadn’t sought out that feeling. (In other words, the joy I experienced when looking at these paintings was illegitimate because I had purchased them on the trip I had taken just to re-experience that feeling that I loved.)
The next thing he asked me to do is to “demonstrate irrelevancy,” that is, to convey to my own brain that the choices I made and the actions I took were not determined or influenced in any way by the spikes. He told me to do everything I would normally do, even though my life was ruined.
Over a period of months, I dedicated myself more consistently to the therapy than I had ever dedicated myself to anything in my life. I did exactly as Steve had instructed. I read one of the cards on which I had written my spikes every half hour of every day and rated the intensity of the spike and the urge to ruminate. Regardless of how bad I felt, I demonstrated the irrelevancy of these spikes by doing everything I would have done had they not been there. I no longer avoided activities or neglected responsibilities with which I had allowed the disorder to interfere before I started therapy. And as tempted as I was to ruminate (try to solve or resolve the spikes), I did not do so.
Although I expected the process to be difficult, I still was surprised when the pain I experienced from my obsession grew worse at first, not better. When I told Steven how miserable I was, he simply said, “Do the therapy. Look at it as an opportunity to utilize your new skills.” I spiked that this struggle and pain might go on forever, and when I told Steven this, he said, “So be it. Tell your brain that it can keep it up forever, and you’re still not going to ruminate.” I wanted Steven to reassure me that I would be alright, but I didn’t ask him to do so. He had told me that reassurance only strengthened the disorder. I explained how much I wanted to ruminate, to figure out what was going on and why I felt so bad, and his response was, “There’s nothing to figure out. The obsession is true. Your life is ruined. Nothing to think about. You sought out that feeling and it altered your life and ruined it. You are absolutely screwed. Guilty as charged. No appeals process.”
As time went on, Steven continued to educate me about my disorder. He told me something that I found strange at first. He maintained that the disorder wasn’t some kind of malevolent entity. “No,” he said, “it’s your best friend who’s concerned about you. It’s trying to protect you, to warn you of danger. It’s just that your best friend happens to be crazy.” He went on to explain how a part of the brain called the amygdala is active when a person with OCD experiences a spike. The amygdala is the part of the brain that warns you of danger. When a car runs a red light and you slam on the brakes and swerve to avoid a collision, the alarm that gets you to take immediate measures to defend yourself comes from the amygdala. Its function is to provide warnings of danger, to activate the “fight or flight” response. That’s all it can do. It’s an alarm system. The rest is the result of your response to that warning.
Steven found it amusing when I told him that I thought my OCD was clever. I said that a psychologist had once told me that it’s as smart as I am. It isn’t. It’s the product of the brain’s alarm system gone haywire. It is prompting you of danger when none exists. The compulsions and obsessions result from your attempts to figure out why you feel you are in such danger. But there is no reason. The alarm is defective.
At first, applying the techniques that Steve taught me seemed to help with the specific spikes that I had written down, but not with the obsession as a whole. As I read and re-read what I had written down on one of the 3 x 5 cards every half hour, that particular spike and the urge to ruminate about it would diminish in intensity. And yet, the overall obsession about having ruined my life remained as strong as ever. As I rendered one spike irrelevant, either it would change into another or a new one would show up to replace it. For awhile, Steve wrote up the cards for me based upon our discussions, but eventually, he told me that I should start writing them myself. After all, he said, I knew best the many ways my crazy best friend came at me. Indeed, it seemed like my OCD would say, “Oh, so that spike didn’t rattle you. Then try this one!”
As the months passed, Steve added new assignments to the ones I already was doing. For example, he asked me to leave things that reminded me of how I had ruined my life around my house. He even had me take pictures of these items and bring them to work so that even there I could remind myself of the disorder’s message. I had a painting that I loved that brought back memories of what I considered the most wonderful time of my life, but when I realized that I had purchased it on the trip I might have taken to experience that special “feeling” I got when traveling, the joy I used to feel when looking at the painting disappeared. So, my assignment was to stand in front of the painting once a day and say to myself, “If I hadn’t taken the trip that ruined my life, I would not have this painting.”
I was very disciplined about doing the exercises, and if I lapsed at all, Steve was always there to remind me of my priorities. Nevertheless, after months of consistent work, the pain I experienced from my obsession had not lessened, and I became despondent. When I told Steve how bad I was feeling, his response was not what I had expected. He expressed little interest in how I felt; he was much more concerned with how I acted. “Just do the therapy,” he said. As hard as it was to continue doing the assignments regardless of how I felt, I learned a really important lesson from this experience: You cannot let how you are feeling determine your behavior. It’s circular reasoning – if you feel bad, you think that something must be wrong. But when you have OCD, there often is no reason for the bad feeling except that a structure in your brain is putting out false alarms, and ruminating about what these alarms mean will only lead you to incorrectly attribute them to unrelated thoughts. What you need to do when you are feeling bad is to accept the feelings and any thoughts that come with it, and then act in such a way as to demonstrate to your brain that these thoughts and feelings are irrelevant to the choices you make, that its warnings are pointless.
I had always hoped there would be a “magic bullet” that somehow would miraculously free me from my OCD. A therapist would say just the right words or I would figure out a solution on my own, and something would click in my brain and the obsession would go away. It was nothing like that. Getting better was more like trench warfare. It consisted of countless slow, painful battles, where I had to fight for every inch gained. The battles went on nonstop, day in and day out.
At one point, I asked Steve how long it would be until I began to feel better. “Could be two weeks or twenty years. It’s all up to you. The important thing is that no matter how long it takes, you continue to dedicate yourself to the therapy.” It was so tempting to look at how I was feeling -- to gauge whether the work I was doing was lessening the intensity of the obsession, to find out if I was “getting better,” but I knew Steven’s response would be, “You’re focusing on the outcome. Stop doing that. There is nothing to think about – you’re screwed. The dividends may come later.” I reminded myself that my life was ruined. “You sought out that feeling and it altered your life and ruined it.”
Several weeks later, I came across some papers in my garage that reminded me with excruciating clarity of the theme of my obsession -- that my life was ruined. I was seized with horror and a sense of desperation that I hadn’t felt in months. On a scale of one to ten, the intensity of the spikes I was experiencing was around nine or ten. All I wanted to do was to ruminate, to figure it out, to do anything that would make the pain stop. But I didn’t. I went upstairs to my room and wrote up index cards for the spikes. Then I demonstrated once again to my brain that the spikes were irrelevant. I didn’t let the spikes and the negative feelings I was experiencing affect my behavior at all. By morning, the intensity of spikes and the urge to ruminate was only in the two to three range, and within a few hours the intensity had fallen to a level of one. I couldn’t wait to tell Steven.
After that, my progress towards recovery gained momentum. The spikes and the urge to ruminate diminished. My self-confidence soared. But I went right back to work and continued to dedicate myself to the therapy.
Steven and I shared an interest in the history of World War II, and when I told him what had happened, he explained it in terms of events from that time. During the war, the Japanese had occupied thousands of Pacific islands. As the allies advanced, if retaking an island did provide them with a strategic advantage, they simply bypassed it. “Think of your OCD as occupying one of those islands. You’re sailing off into the distance, and the disorder is yelling, ‘Hey, where are you going? Come back and fight!’”
I couldn’t believe it. After all the years of getting nowhere with my OCD, I was finally getting better. And then I experienced something I had read about called the “Extinction Burst.” I was flooded with spikes, hundreds of them. So many that they piled on top of, and merged with, one another. It was excruciatingly painful, but I didn’t care. I knew this was a sign of my recovery. It lasted for several days, and then all at once, the spikes were gone.
There are times when language seems too limited a medium to express the enormity of one’s experience. Not only was the pain gone, but I was filled with a rediscovered love of life. I had gone from wanting to fade away and die to savoring every moment of being alive. All of the conventional problems of life seemed insignificant by comparison. Steve put it this way: “I’ve been told that OCD is like having your house on fire, and all the rest of your life is a single lit match.” The only part of that statement I would change is that it wasn’t my house that was on fire -- it was me.
And now, the fire was out.
A few days later, I was thinking about going out for my Friday night dinner and cocktails at the restaurant I usually patronized, and suddenly I spiked “If you drink alcohol, you will kill all of the brain cells that made your recovery possible! You will ruin your recovery.” My anxiety returned. All I wanted to do was to ruminate, to figure out the problem. Thoughts like “It’s just a little thing – give up alcohol for the rest of your life and you’ll be fine” raced through my mind.
I desperately wanted to talk to Steve about what I was experiencing. I pictured myself telling him and how he might respond. I imagined him looking terribly alarmed and concerned. He would get that look he gets when he is deep in thought, processing what you’ve just said. Then, after a while, he would say, “Well, it’s a scientific fact that alcohol kills brain cells.” But when I actually told him the story, his response was anything but what I had expected. He asked me, “Did you embrace it (the spike)? Did you say to yourself, ‘I’m going to drink so much that I will wipe out all of the gains I have made and never recover again?’”
I think, at that moment, I “got” it.
It was the most important moment of my recovery. I suddenly understood what Steven was doing. Up to this point, I had done exactly as he said. I didn’t always understand why I was doing something, but I followed his directions to the letter. Now I understood what he was saying. The OCD has to be satisfied that you’ve been warned. As Steven said, “It’s just your crazy friend who’s so concerned about your safety. Your best friend needs to know that you are aware of the danger. Then it is satisfied that its job is done.”
I continued to carry the index cards on which I had written down my spikes with me, but instead of reading one every half hour, I read one every hour. I also kept a few blank index cards with me – in case my best friend tried to warn me about something else. Steven said my attitude towards the OCD should be, “Keep it up, motherfucker, and you get a card.”
A few weeks later, I started planning a little vacation trip to California. It was a bit of a stretch for me to afford it at that time, but I hadn’t gone anywhere since I started working with Steven. I was so excited – a vacation without the obsession! But suddenly, that familiar feeling of anxiety came over me. I felt a vague but powerful sense of concern that something was wrong, and I experienced all the familiar physical symptoms of anxiety – increased heart rate, rapid breathing, and feeling sick to my stomach. What I was feeling had all the characteristics of my typical response to an OCD spike. I knew it had something to do with the trip I was planning and my motives for taking the trip in the first place. I desperately wanted to think about it, to figure it out, to ruminate, but I would not let myself do so. I wrote up a card that said simply, “You’re fucked!”
By that point in my therapy, the urge to ruminate usually faded over time, but this one kept going strong. The spiking and urge to ruminate continued unabated. When I had my session with Steven, I told him what was going on. I couldn’t make up a card with the particular fear I was experiencing because I didn’t really know what that fear was. In order to determine that, I would have to ruminate, and I wouldn’t allow myself to do that. Steven’s response was, “Just let it hang.” I told him that I thought I was going to keep spiking until I figured out what was wrong, and he said, “Then, take it to your grave.”
At that point, Steven articulated yet another critically important concept. He said, “You do not get resolution. Your OCD is trying to engage you, to get you to solve the problem. You do not get that luxury. There is nothing to figure out. That is the great illusion the OCD creates. I cannot stress the significance of this concept enough. You do not get resolution.”
I asked Steven how long he thought it might take for me to get some relief. He replied, “Be prepared to hold out as long as it takes, even if it is the rest of your life. The OCD has to know it’s done its job, that it has warned you.”
A few days later, I left on my vacation. My best friend was silent, satisfied that I had been warned. From that point on, nothing was the same. The fight of my life – for my life – was over, and Steven and I had won. We discussed the techniques had facilitated my recovery. There were certain fundamentals: Embracing the threat and the fear, refusing to ruminate, no longer seeking resolution, demonstrating irrelevance, and not letting the way I felt influence my behavior. Steven also had taught me to respond to my spikes without panicking, to respond in a way that demonstrated that I had heard my best friend’s warnings. I learned to acknowledge my brain’s warnings with responses like, “Yes, thank you for pointing out that danger to me,” or “Yes, I know I’m making a terrible mistake,” or “Yes, I know I’m in great danger,” or “Yes, I am doing a foolish thing that will hurt me.”
Another thing that Steven did – or didn’t do – that was essential to my recovery was that he never reassured me that the danger about which I was spiking wasn’t real. It took me a long time to understand why this is so important. We had to ensure that the OCD – my crazy best friend – was satisfied that I had been warned. To seek reassurance would signal to it that I hadn’t fully accepted its warnings.
At one point in my recovery, Steven upped the ante on the OCD. He said, “I want you to become cocky with the OCD. I want your attitude to be “Bring it on, mother fucker! Is that the best you can do?” At first I was surprised by this suggestion. Now that my OCD was retreating, my inclination was to play it safe, but I did what he said and challenged and taunted the OCD. I think Steven asked me to do this because he realized that even though I was well on my way to recovery, I was still afraid of my OCD -- I still thought it had power over me. By treating it so cavalierly, I demonstrated to myself that I had nothing to fear from it, that I was in control, not the OCD.
After applying everything I learned from Steven to all the other types of OCD that I had, after I was no longer being tricked into ruminating (trying to figure out the problem) when I spiked, my internal dialogue changed. Before I began seeing Steven, when I experienced a spike, I would immediately argue, debate, wrestle, and/or bargain with it. In other words, I would ruminate. But now a spike would hit and I would respond with “Oh, no, we do not discuss these things while spiking.” Later, I adopted a shortened, more direct version of this: “Go fuck yourself.”
Now my crazy best friend is silent most of the time. Sometimes he whimpers a little, and once in a great while, he screams. When that happens, I simply acknowledge his warning and move on. If he persists, I tell him to “fuck off.” I still carry my cards with me, ready to write down any spike that refuses to go quietly. And I am in awe at how my life has changed.
Now, when I look at that painting I love, all the joy I thought I would never feel again has returned.