Graduate Story #8
Getting away with Murder
I have suffered from obsessive worry since I was about 9 or 10 years old. I feared I didn't know how to read. And then I feared I could read but I would cheat on my homework assignments by not finishing my reading. The only way to be sure was to read everything aloud, so that's what I did. In summer camp when I was almost 10, I thought I might have peed a little in the pond -- but wasn't sure -- and stayed awake all night, worrying, until I confessed to my camp counselor who reassured me that even if I had, it would be okay.
Then, I began obsessing about whether or not I was racist and spent hours dissecting it in my head. Then I feared I would do something racist. I feared I would write something racist in my school work and submit it to my black 7th grade teacher. Maybe I would give a person of color a dirty look. I tried to always monitor my face. One day I couldn't take it anymore and gave a dirty look to a black girl at the library. I was devastated with guilt. That night I wouldn't let myself eat the candy letters -- my favorite part -- off a family member's birthday cake as punishment.
When I was about 11 or 12 my OCD took on the primary theme that it carries to this day -- child molestation. I began baby-sitting and when I would come home I feared I had molested the children I had cared for. There are too many instances to recount but each time went the same way. I would be consumed with terror before I went on the job. Then I went and held my breath, hoping I wouldn't molest the child, hoping I wouldn't get home and think I had. But, inevitably, there would be a moment that I would replay in my head -- going over it and over it hundreds of times, trying to figure out if I had molested anyone, always thinking, before hitting the mental "play" button, "Okay this time I'm going to answer it." Once I was sitting on the couch while the boy I was baby-sitting watched a movie -- he at one corner, I at the other. During the movie, I became terrified I would or had molested him, even though we were so far apart. One time there was a girl across the street - had I touched her somehow? I tried to create a bubble between myself and any child (a ritual I practiced for the next 18 years or so) to be sure I couldn't molest them. Any motion forward, any flex of my fingers were suspect. Most of the time my ruminating wouldn't answer my question and I had to confess. So I told my parents. I would confess to them after each baby-sitting job: "I think I did this..." "But you didn't," they'd always say. "But what if I did?" I would always ask. "Even if what you're describing happened -- did I purposefully push my breasts against the child during a hug? -- you didn't hurt anyone."
For years whenever I heard sirens I feared the police were coming to get me. I switched through television channels looking to see if there was a news report about me. The spikes morphed and I began obsessing about killing someone. One time I thought I had killed an old woman who worked in a store. I finally had the chance to return to the store a week later. When I saw her alive, I was filled with an indescribable joy. I floated on my walk home. Another time I became convinced I would murder my parents in my sleep so I stayed up, standing guard against myself.
During these years, no one knew except my parents and me. We had no idea what was happening. My parents were filled with love for me and desperate to help. They listened to my confessions, reassured me endlessly and hoped, as my mom told me later, it was a phase that would pass. All this time, I did well in high school, had friends, had crushes. Finally, before my senior year of high school started, I asked my parents if I could see a therapist -- I didn't know what was wrong but I knew I couldn't go to college like this. The first one diagnosed me with Obsessive Compulsive Disorder but said she didn't know how to treat it. The next therapist my parents had known for years. She too diagnosed me with OCD. I began medication and started seeing the therapist once a week for the next year. While her specialty wasn't OCD and she wasn't a cognitive behavioral therapist, she was compassionate, caring and helped my parents and me cope. To be honest, I don't think I was ready for anything more.
Until I was 28 years old, I went from therapist to therapist, starting, then stopping after a few weeks. I stayed on medication but changed those often too. My OCD would flare up, then subside. My life went on. I ritualized to keep my OCD in check -- avoidance of children when I could, reassurance, confessing and ruminating. The therapists I saw would talk to me about alleged low self-esteem. They'd reassure me. One gave me a knife and told me to poke his hand with it. When I refused, he told me that was proof I wouldn't harm someone. Most shrinks told me my OCD was unusual because I had no compulsions (that they could see) and because I believed so strongly in my spikes, I didn't see them as absurd. One therapist thought I had epilepsy, not OCD. (He was wrong.)
In 2008, things were going well -- amazing boyfriend (now husband), great job, loving friends and family. And, suddenly, the OCD began to take over. My spikes were now everywhere -- I feared robbing people, carjacking people, molesting children, molesting adults, tripping people, pushing people into traffic, pushing people down stairs. It hadn't been this bad in years. I had intrusive thoughts and impulses during almost every waking moment. My only relief was sleep. And when I awoke, I was always disappointed.
The only way to guarantee I wouldn't commit a crime was to stay home. When I did have to be outside, I ritualized. I walked as far away as I could from people. I returned to stores that I thought I robbed to check -- if I'm here and no one says anything, I'm good. I made up excuses to talk to people I thought I had molested to gauge their reactions to see if I had done anything. I always thought the police were coming. I tried to figure out the trigger of my breakdown so I could excise it from my life and then, I thought, stop this torment.
I went to work but otherwise confined myself to my apartment, although that wasn't a safe haven either. I started spiking about murdering my boyfriend or molesting my dog. I cried constantly. I could barely function. I looked into going to a hospital but my insurance wouldnt cover it. I wasnt suicidal but I didnt want to live anymore. I wasnt seeing a therapist -- I hadn't for years -- but was still on medication. I saw my psychiatrist weekly, both of us hunting for a medication that would stop the thoughts.
For the first time I sought out a cognitive behavioral therapist. I found one on my insurance. She was kind but incompetent. She had me write down nice things about myself. She said I repressed my emotions. She suggested on one of my first visits that I try to walk a little closer to children on the street. Right, why didn't I think of that? If I could do it, honey, I wouldn't be here.
Through some internet searching I found an OCD support group at the Center for Cognitive Behavioral Therapy and began going. I was a wreck and couldn't even speak in group. They all had OCD, I thought, but I didn't. I was a monster. I felt even more alone. After a couple weeks, though, I decided to meet with a therapist at the Center. I was desperate but still hopeful. I hadn't given up.
After meeting with a therapist there, I broke up with my other shrink and started at the Center, seeing someone in individual therapy twice a week, and attending group once a week. These sessions and people became a lifeline. (I also started on an SSRI (lexapro) which helped with my depression.) We began working on my hierarchy and starting exposures. Slowly, I stopped ritualizing and I began employing the skills the Center taught me to use. I learned that nothing would stop my spikes, my thoughts, and that my goal was not to banish them, but to, as one group member so eloquently put it, coexist with them. I learned not to cut things out of my life that spike me but to prepare for and welcome the challenges. I've learned that when I spike, I can choose to answer the alarm bells in my brain with -- "Maybe I did do that, maybe I did." And then not to confess, problem solve, check, punish myself. But to just go on. (I often remind myself of one group member's wisdom when he likened ritualizing to scratching poison ivy. It feels good for an instant but then spreads.)
My therapist and I started by preparing a hierarchy of my spikes. A hierarchy is a list of your spikes, from the least challenging to the most. I had always feared exposure therapy because I imagined that the therapist would just throw me into a daycare for a day. But, at the Center, you start at the bottom of the hierarchy, with the least threatening spikes. This is done for the same reason you don't start your first day of weight training by picking up a 500 pound barbell. As one group member explained it to me, your brain is a muscle and by doing the exposures you're strengthening it. So you start with 2 pound weights, then 5, then 8...
I began at the bottom -- fearing I would purposefully move an object (twig, leaf, garbage) on the sidewalk so someone would trip and fall, or I would kick something into the road, causing a car accident. My exposure was to take drink bottles and place them on the sidewalk and outside people's homes, right by their front steps. There is a back stairway at my work so I put a bottle right in the middle of the stairs. I was instructed to kick bottles into the street when I came across them. Accompanying these exposures was a mental exposure of sorts -- telling myself that maybe someone had tripped and hurt themselves because of my actions. And, I was not permitted to go back and check to see if anyone was hurt or to remove the bottle. Prior to tackling this on my hierarchy, I had spent hours retracing my steps outside, moving the debris I feared I had moved or looking for injured victims.
(I should note that my therapist and I did the exposures together during my therapy sessions but -- and this was crucial -- I also did them every day on my own. The exposures became part of my everyday life, like going to work or eating. For me to improve, I could not relegate them to an hour a week. I had to make them the highest priority in my life.)
Slowly, I began to move into the spikes that haunted me most -- crime spikes. Because I feared I would rob stores, my therapist told me to walk into stores, hiding my hand in my pocket and making a "gun" sign. I was instructed to go to the counter and buy something and then mumble unintelligibly, "Give me your money." And, then, again, to leave the store and not return to check, but instead to tell myself -- "Maybe I robbed the store. Maybe the police are looking for me." To this day, this spike nudges me so I still often do the exposure when I shop. When I'm at the check-out, I'll place my hand on the counter and make a gun sign, as if that's just how I rest my hand. And I'll think to myself, "Give me all your money." Maybe I'll hum while I'm thinking this or even just have my mouth partly open.
Higher on my hierarchy was my fear of molesting adults. My therapist and I walked around New York and went to Grand Central Terminal where I was instructed to walk as closely as I could to adults, swinging my arms. My therapist had me walk back and forth in crowds of adults in Grand Central. She would tell me to make contact with 10 adults so I would swing my arms in the crowd, brush shoulders.
This laid the groundwork for my exposures with child molestation. However, we started off small. Within each step of the hierarchy, there's a mini hierarchy. We began with me standing within maybe 5 feet of a child and then sitting at a table next to a family at the food court. Slowly, we then began to replicate the exposures I had done with adults -- I had to make contact with children. We went to the zoo, where I was told to make contact with 10 children. Words fail me in describing how difficult this was. Sometimes I felt like I couldn't do it or didn't need to. But my resistance made it clear that I needed to tackle this. Finally, I baby-sat my five year old niece for the day. Before this exposure, my therapist and I created a list of things I would do while I was baby-sitting - touch her leg, push my chest to her when we hugged, wrap my arms around her waist area when she sat on my lap. On my way home from the 12 hour exposure, I bought vodka and a bag of potato chips.
Accompanying these exposures and spikes that continue to come up in my day-to-day life, I made and continue to make notecards. When I fear that I grabbed a child's butt in a store, I'll take an index card and write, "Maybe I grabbed the child's butt in the store. Maybe the police are looking for me." I then replace my mental rituals (such as, ruminating) with the words on the notecard and look at the notecard as much as I can. (For some stubborn spikes, I set up a reminder on my phone and on my e-mail that delivers the message on the notecard to me at least once a day.) Sometimes just the act of writing it on the notecard helps enormously -- I'm making a commitment, a choice to not ritualize and, somehow, that brings relief.
When I used to spike that I had pushed or tripped someone on the train stairs I went up and down the stairs countless times, checking and looking. Now when I spike about that, it feels just as real but I make the choice to accept the risk that I killed/harmed someone and I'm getting away with it. It's terrifying at first but so much better than the alternative.
Recently I had my eyebrows waxed and the woman rested her hand on my mouth. I became terrified I would kiss her hand, violate her, molest her. By the time I left I was convinced I had kissed her hand. On my walk to the subway I began going over everything in my head. I told myself that to respond therapeutically meant letting myself off the hook. After all, this one was different, this one was real.
I saw where I was headed. Real or not, I was engaging in the same rituals I had done a million times before. So I made a decision as I got on the train to respond skillfully and tell myself that maybe I really did molest her, I was going to take that risk. Maybe I was letting myself off easy, I was going to take that risk. On my way home I repeated to myself over and over again: "Maybe I kissed her." And it worked. Unlike the ritualizing, this didnt last for days. I felt better by the time I opened my front door. Maybe I molested her, maybe I got away.
Getting to this place took 1.5 years of therapy at the Center and I still work at it every day. I remember when I first heard of the Center's treatment I didn't think it would ever work for me. Itsounded ludicrous -- accept the risk. My life had been about avoiding the risk and searching for certainty. But the treatment did work, slowly, and it's saved my life, it's given me my life.