Graduate Story #15
The Poison pen (by Tom)
An amazing recovery from metaphysical contamination OCD, involving the shortest recovery time from an severely disabling condition
I’ve suffered with OCD since I was a teenager, although I didn’t even realize it was OCD until I reached my mid-twenties. I’m in my mid-thirties now. Until starting therapy this year, initially with James (one of the staff therapists) before transferring to Steve, I experienced a steady decline in my quality of life over these past ten years. Just imagine a photograph of yourself that you leave on the window sill and watch it become more and more sun-damaged over time, until one day you can barely recognize the person in it. I’m sure plenty people who read this will be able to relate.
My first inkling that my brain might be operating a bit differently to others was when I hit puberty and started masturbating in my teenage years. Growing up in a conservative Catholic family it was no real surprise that I came to view the act as dirty and something to be ashamed of. Nothing terribly unique or surprising about that mindset considering my home environment. However, to rid myself of this guilt, I started a ritual of avoiding doing anything of personal significance (in terms of purchasing something or going to an event) in the 24 hours following masturbation. I did this to avoid that item or experience becoming ‘tainted’ with the memory of me having masturbated in the previous 24 hours (metaphysical OCD). I pretty much had a schedule for when I masturbated to avoid this tainting and as long as I followed it everything was hunky-dory. At times when I messed up my schedule or if something unannounced/unplanned happened within a 24-hour ritual period, I would simply discard that item or not go to an event (if I did go I made sure to keep it low-key and very unmemorable). This simple ritual contract with my brain ‘worked’ – as long as I do this ritual, you (brain) will stop sending me distressing thoughts and emotions. Deal! Or so I thought. Unfortunately, this contract became more complex as time progressed, and when a number of events played out in my life in my mid-twenties (death of a close friend to suicide, as well as other more typical life events) I started to lose control and my OCD proliferated to pretty much all aspects of my life.
The spikes (intrusive thoughts) and associated emotions were completely outside of my control, but the immediate period after their emergence was under my control. I didn’t understand that distinction at the time, and I relinquished so much power to it and became the architect of my own troubles and challenges. I’ve come to understand that OCD has an insatiable appetite when it comes to taking over one’s life. It’s also an incredibly distrustful negotiator – the more I tried to bargain with it to get back to some form of my old ‘normal’ (my teenage years), it would always accept my offerings for a while before remerging with new demands. I liked to think of it as the great shape-shifter: you don’t know where it will show up next and in what form. I vividly remember my life crumbling around me at that point and fearing that I was entering a period of my life that I would never recover from. I was truly scared and my typical head-down-and-get-on-with-it strategy didn’t work. I believed for a long time that the remainder of my life path was cast in stone. I was seeing my enjoyment in life decline, as the walls of the OCD symptoms closed in around me. My low points kept getting lower. At my worst, I thought about leaving my partner as I felt I would be hopeless as a partner and she would be better off without me. I spent so much time ruminating in internal Tom land during this time. It became very clear very quickly that I needed professional help to get better.
That professional help came in the form of several therapists on and off over almost a 10-year period, none of which were specialists in the treatment of OCD. I didn’t seek out OCD specialists because I didn’t realize I was suffering from OCD at that point. I entrusted myself to these people and believed their recommended approach of talk therapy would solve my problems. While helpful, these sessions never produced enduring results. I think the lift I got in the short time after these sessions was mainly from cathartic release and the relief from having sought help for my mental health (not something I found easy to do in the first place). When I think back now, I see why these sessions and treatments weren’t a good fit for me: trying to rationalize with OCD is futile – I might as well have tried talking to a brick wall. I also went down the pharmacological route for a short while. For me, the medication was a welcome crutch that helped me achieve some relief, but it really only masked my symptoms. I never truly believed that medicines would get to the crux of my problem and resolve it (even though at times my OCD tried to persuade me it was the only way).
During this period, I began my own research into my symptoms in earnest. I thought the depths of Dr Google must harbour the story of someone else that is affected by something like this. If I can just find that article/podcast/blog/video I will understand what this thing is and how I can overcome it. I spent so long trying to understand my yet-to-be-diagnosed OCD and why it decided to take up residence in my head. Hands up for anyone that spent hours upon hours researching their symptoms? Yup, I thought so. I had my suspicions that I may have had OCD with quite a while, but I never found anything that exactly overlapped with my symptoms. Nevertheless I did get some brief moments of relief and optimism after reading some online articles. I remember naively thinking I could finally overcome this mental challenge and could live the life I wanted. Unsurprisingly these transitory uplifting feelings never lasted long. Not only did they not help me with my OCD, but I believe this reassurance behavior put me into an even darker place than where I began from: I started to believe that these constant ‘failings’ (the inevitable re-emergence of symptoms) were proof that I would never be able to overcome my OCD.
All this while, nobody was able to tell me what I was suffering from. It wasn’t until about 18 months ago (early 2021) that I was given an OCD diagnosis by a psychiatrist (following a referral from my doctor). Finally I thought, I know what this thing is. I immediately started searching for OCD specialists and it wasn’t long before I landed at Dr. Phillipson’s website. I read and listened to some of his online material previously and considered him to be a world-leader in this area, so I plucked up the courage and reached out for an appointment. It’s only now I appreciate how significant that step was. I could easily have not done that and still be enslaved by my OCD.
I started therapy with Steve earlier this year. It wasn’t until after I had a few sessions with Steve and he described OCD that I began to understand it properly. Even more importantly for me, I learned what would be needed for me to get better. Despite all the previous research I did, I did not understand OCD – a classic case of truly understanding something being very different to drowning it in information. I’m not going to describe what I think of OCD or how it operates, as I think the ‘Choice’ article does a great job of that. However, one of the fundamental steps toward recovery for me was developing an understanding of the difference between the Machine and Gatekeeper; I can control Gatekeeper but the Machine I cannot, so why try to influence it? Why would I accept or endorse a dark and distressing thought from an independent system over which I have no control? Of course, understanding this doesn’t make them disappear, but it does help in not taking ownership of them.
After a few sessions with Steve, he quickly described what he thought I was presenting with: metaphysical and character indictment OCD. They were both somewhat intertwined, as I carried that 24-hour tainting ritual into my character indictment OCD. Basically, I would have a 24-hour ‘taint’ period after having a distressing intrusive thought, whereby the Machine would label me a monster for having it (no different to if I had masturbated). As anyone with this type of OCD can appreciate, my independent system had a field day when I gave it this license to attach a ‘taint’ ritual to every unwanted intrusive thought.
My treatment was similar to others – Exposure with Ritual Prevention (ERP). Steve and I agreed on a set of exposures to various intrusive thoughts (starting off easy), and then I would actively ‘taint’ items within the same 24-period as having that particular thought. This would then be followed by active exposures to the tainted item. The first exposure ‘taint’ item was the title of this article: I associated the thoughts of a family member getting a terminal illness with an orange pen I purchased and carried around with me. I undertook the exposures on a weekly basis, with exposures ramping up in perceived difficulty each week. If you’re still reading at this point, you’re probably wondering what golden nugget I have to explain how I succeeded in getting through the exposures? I think none, but I will describe what I kept front and center of my mind when doing the exposures.
Because I’d (unknowingly) given so much of my life to OCD already, I had reached a point where I was committed to taking back control, regardless of what I had to go through to get it. I had no idea of how much of the cycle that I kept fueling. It’s hard to describe but I just knew this was the right time in my life to tackle this. I fully expected this to be easier said than done, but I was firmly committed to doing this. I knew what living with OCD was like and I didn’t enjoy it. I was honestly terrified of doing the exercises, as it meant active exposure to the distressing thoughts that I had spent so many years trying to escape by ritualizing. Before I started the exposures I couldn’t envisage myself getting all the way through them. One thing I told myself that helped was that I might as well be distressing myself to get better, as opposed to getting worse. For me, if there is a golden nugget of advice, it is to stick regimentally to the exposure schedule. I was completely committed to the exposures, as distressing and all as they were initially. I viewed my therapy as a kind of last-chance saloon. I felt if I jeopardized the chance of treatment success by not fully committing to these exposures with a therapist like Steve, what other options do I have? I didn’t want to ruin what I believed was my best chance of success, as if this failed because I didn’t play my part, then I would be the one to suffer and lose out in the long run.
The hardest part of the exposures for me was the anticipation, at least in the beginning. I still remember the first exposure and how awful I felt on my way to the checkout to purchase the Poison pen. From my history with OCD over the years, I was expecting a full and firm emotional backlash from the Machine for not getting rid of this tainted pen immediately. But I stayed the course and purchased it. What happened next shocked me. Despite the flood of anxiety and racing intrusive thoughts while I was in the store, these quickly dissipated within a few days as I was doing the hourly re-exposures. I wasn’t expecting the Machine to back off so quickly and that took me by surprise. My trepidation proved to be largely unfounded as the exposure played out: its bark was definitely worse than its bite. This was very enlightening, and it made me realize two very important things that helped me complete the remainder of my exposures: (i) I can get through these exposures if I chose to (despite my apprehensiveness) and (ii) the backlash isn’t nearly as severe or as long-lasting as I anticipated. Over the course of the next month or so, I undertook all of my exposures. I did them at a much faster pace than I thought I would. This was mainly because I had gained so much understanding and confidence from my aggressive approach that I wanted to maintain my momentum; I really wanted to grab the bull by the horns and prove to myself I can have the control whenever I chose it. I felt that any deflecting or delaying of exposures is only giving credence to my OCD. I can only now appreciate that me adopting this mindset was a big turning point for me on my road to recovery. The Machine did intrude with some very dark non-exposure-related intrusive thoughts during this time, which I saw as its attempt to grab my attention seeing as I wasn’t obeying its commands to ritualize. But, I came to realize that with practice, you can ignore a thought scoring 10/10 for distressing nature, just like you can ignore one that scores 1/10 (more on that in the next section). They’re both equally irrelevant.
Of course, I still had (and have occasionally) some tougher days. Days when I’m stressed about something, I’ve received news I’ve found upsetting, I didn’t get a great night’s sleep, etc. – the emotional variability present in the life of all human beings I guess. At first, I dreaded these days because I felt the intrusive thoughts were louder and generally more attention-grabbing and stickier. But now I’ve come to realize that the thoughts on those days were really no different to those on any other day; it was just that I found it more difficult to maintain my resolve, and instead I reacted to them. However, working with Steve gave me the understanding that part of the human experience is to have moments of weakness. Despite years of trying to safeguard myself from them, I can’t control those moments. Developing an awareness of this made it easier for me to recognize that these days required a conscious effort on my part to remind myself to keep doing what was, and still is, working – continue to not react to the intrusive thoughts. I’d been reacting to these intrusive thoughts for many years, so I didn’t expect to form a new habit overnight. I allowed myself patience for this new approach to bed-in over time. This improved awareness helped me immensely in maintaining my resolve on my ‘weaker’ days. I now understand that I was never going to recover from my OCD just on my ‘good’ days. Instead, I think making progress on days when I didn’t feel like taking on the Machine were (and continue to be) the most important. I think these are the pivotal battles for me to win in my fight to fully regain control.
Sitting here now with the benefit of hindsight, I realize I didn’t actually know what success looked like before. So how could I ever have achieved it? I now see the goal isn’t to not have these intrusive thoughts or the emotions associated with them, which I naively believed before. Instead, I view success as maintaining a resolute mindset to not alter my life in any way in response to their presence or the demands of the Machine. I still have intrusive thoughts frequently, but with practice I see that I can choose to not be controlled by them. The less attention I give them, the less frequent and less bothersome they seem to become. The song ‘Don’t Fight It’ by the Australian band The Panics pretty well encapsulates what I have set down as my default response for intrusive thoughts, even for when I’m unsure if it is an intrusive thought or not (or an associated emotion). Having said that, I’m well aware that if I take a backward step then I’ll relinquish power to the Machine, so it’s an ongoing process. I consider myself to be well on the road to recovery, and I’m looking forward to seeing where it takes me from here. Therapy with Steve has also helped me in numerous other ways, not just related to OCD.
If I read this article in previous years I would have been skeptical of its recovery claims. I would also have thought lucky for that person because they must have a mild form of easily treatable OCD. I simply wouldn’t have believed it possible to achieve the same and rise out of the quicksand I was stuck in. Obviously, I can’t tell what you are going through or what type(s) of OCD you are experiencing. All I can say is that I would not have believed I would be sitting here writing this about six months after starting therapy with Steve. But I am. I still have my Poison pen and the other ‘tainted’ items from the exposure, which I genuinely enjoy using. For anyone reading this who can associate with my story, do yourself a favour and reach out for help. Not tomorrow or next week, but today – don’t put it off like I did. Despites its obvious challenges, I had fun, and it’s one of the best decisions I’ve ever made. I simply stuck to an agreed plan and am seeing the benefits of that play out in my life in ways that I didn’t think possible. I believe if I can follow a plan and get better, so can you.