OCD and Reflections on September 11th
by Steven J. Phillipson, Ph.D.
Clinical Director, The Center for Cognitive-Behavioral Psychotherapy
In general, when real life delivers a crisis, persons with anxiety disorders, and specifically those with OCD, tend to manage these crises somewhat more effectively than the population at large. The very nature of Obsessive Compulsive Disorder is the mind's relentless and endless effort to process and prepare for the most extreme nightmarish scenarios. The anxious mind compels people to mentally anticipate the worst possible scenario and not the negative outcomes which life typically delivers. Our usual world predominantly delivers circumstances to us which don't come close to matching the level of negativity that people with OCD consistently prepare themselves for.
Subsequent to the September 11th tragedy, it has been my observation that the general public is reacting in a more exaggerated way than would a person with OCD. The general public has been hit by this real life crisis in a way that's caught them completely unprepared. So now, for those who do not have OCD, white powder, possibly representing bio terror, low flying planes, and being above the tenth floor of any building, presents an association of their own vulnerability to the extreme of terror. In contrast, persons with OCD tend to be biochemically fixated, on the theme of their previous condition prior to September 11th. For example, their neuro-chemistry could be a lot more distressed about the potential of suffocating their own child, or of possibly being gay, than with managing the ambiguities of white powder or low flying planes.
There is, however, a segment of the OCD population which will be noticeably more affected by these events, as will be the anxiety disordered population in general. Persons with OCD who suffer from contamination concerns are going to be more prone to cleaning off all dust particles or to hypervigilance about hand washing, and might consider buying protective devices such as gas masks or antibiotics. Persons who have a fear of flying will tend to have their condition exacerbated by the ambiguities of those who are concerned about crashing, as opposed to those who are more concerned about having panic attacks on board in flight.
An interesting phenomenon took place for many of my OCD patients in the weeks following the September 11th tragedy. Specifically, there was a very dramatic and evident trend characterized by a direct relationship between the degree of patient progress and the proportion of time spent processing the way in which this tragedy has affected them or the world. Those persons who have not yet received the benefit of behavior therapy have tended to either ignore, or devote no more than five minutes of session time processing the tragedy and instead devote the entirety of their therapy sessions to the ongoing process of their therapeutic agenda. This reflects the intense and overwhelming need experienced by the OCD sufferer to find relief from the urgent dilemma created by their obsessional focus.
A recent theme, and I think a very relevant concern, for a number of my patients who are more of the obsessional nature, is the threat of what might be termed "blood lust." There is a tendency for humans to find a sense of exhilaration or excitement at the idea of going past a car accident and seeing some unknown horror. It is also the case that some people become excited by the prospect of the death toll being exorbitantly high or find a thrill in watching and re-watching the inconceivable sight of the World Trade Center buildings collapsing. For those persons with the purely obsessional type of OCD, who are concerned about their own righteousness of character, this human tendency to be attracted to horror provides a fairly new spike theme. This spike involves believing that one has a personal defect in character as indicated by their interest in watching programs, like CNN, which provide one with sights and information on crises, new traumas and human suffering. It is important to understand that this appeal of the morose is basic human nature. We tend to be somewhat disappointed on an emotional level (not necessarily on a cognitive level) when we hear that a hurricane veered off course and is not going to kill hundreds of people in low-lying areas in our neighborhood.
It is important to understand that we all found a certain fascination in watching the World Trade Center buildings collapse or in fathoming what it might be like to have been on those planes that slammed into the building. From a therapeutic viewpoint, it is important for us to let go of finding an answer as to whether or not this basic thrill, this basic tendency for humans to find fascination and appeal in the potential horrific suffering of others is indicative of severe psychopathology. This fascination is not in fact related to a character deficit, but is indicative of nothing more than our basic human curiosity. Specifically, we are better off not seeking answers to such questions, but rather should accept the sometimes surprising complexities of being human.
The tragedy of the September 11th disaster has unfortunately created an opportunity for all of us in the general public to experience the preoccupation, anxiety, and torment related to the uncertainty of the future that OCD sufferers live with consistently until their disorder is appropriately and effectively treated.