O.C.D., My Exhausting Best Friend
Ever since I was young, my mind has gotten stuck. I’ll be flooded with intrusive thoughts. An image or an idea will transform into a burning question — “What if I left the stove on?” “What if the door is unlocked?” “What if I lose control and do something violent?” This plays on an endless loop.
To cope, I constantly seek reassurance by reviewing my actions, trying to replace my thoughts or using logic to undo what is utterly illogical. But all those efforts fail, instead energizing the thought, resurrecting it like a zombie on steroids, making it more vicious, resistant and cruel.
That’s a snapshot of living life with obsessive-compulsive disorder, an anxiety disorder that afflicts nearly 2 percent of the population. With O.C.D., the brain misfires, causing it to malfunction and react to disturbing thoughts, images and ruminations. The sufferer tries to manage his anxiety with compulsive rituals, which include excessive double-checking, counting, repeating a prayer or mantra, and engaging in mental reassurances that give a short-term relief but ultimately become addictive crutches, fueling an endless cycle of torment.
O.C.D. has often been misunderstood, undiagnosed and exploited as a set of amusing quirks for Hollywood characters. I wish my O.C.D. was as fun and lovable as depicted in “Monk.”
At one point in my life, I endured an endless stream of tormenting thoughts about sex, overwhelmed by visions of every vile variation, partnership and arrangement imaginable. They would make Caligula blush.
When this happened, feelings of guilt, disgust and shame would inevitably begin to overwhelm me. Self-doubt bubbled up and asked: “What sick person could imagine such things? Surely, there must be something wrong with you?”
Here I am, a somewhat intelligent, moral, responsible individual fully aware that the thoughts are irrational, but nonetheless I must perform ridiculous rituals to try to feel safe and achieve relief.
I think of it as God’s sick joke.
“All of our brains have these naturally occurring very edgy ideas,” Steven Phillipson, an expert on the disorder, told me. People imagine jumping in front of a train or smothering their child, or a host of other violent, sexual and blasphemous actions. Everyone has these thoughts, but “without O.C.D., the person dismisses the brain’s offerings,” Dr. Phillipson explained, with the mental event passing after three seconds. For people with O.C.D., however, it’s a “tsunami of emotional distress.”
Dr. Phillipson compares O.C.D. to a best friend who desperately wants to protect us but warns us about threats that are never legitimate. I obviously need a new best friend.
Most people wouldn’t guess that I’m constantly tortured by disturbing thoughts. I’ve hosted live TV shows and given speeches in front of large audiences. During the LSAT, a few friends from college sat next to me because they said I had a calming energy. They had no idea of the internal storm always raging in my mind.
As far as acting on my thoughts and fears, I don’t: I’m possibly the most boring man on earth. I’m married with kids, don’t drink or get into bar fights. This makes sense. “Themes of O.C.D. have no absolutely no implication about the character of a person,” Dr. Phillipson said.
David Adam, author of the memoir “The Man Who Couldn’t Stop,” told me, “O.C.D. makes everything harder.” His book describes how he confronted his own O.C.D., which involved an intense, irrational fear of contracting H.I.V. We agreed that O.C.D., like all mental health afflictions, is not an artistic muse or creative gift but is ultimately unfair, with no complimentary benefits. Even though he likens his condition to being a recovering alcoholic, Mr. Adam was thankfully able to treat his O.C.D. and eventually write two books after he did a form of behavioral therapy called exposure and response prevention.
This is the most successful treatment for O.C.D., and it involves repeated exposure to the fearful thoughts without giving into the short-term relief delivered by compulsions. The trick is that you can’t outthink the disorder, you can’t outargue it, you can’t outrun it. You have to make the voluntary choice to confront it. It’s like inviting Pennywise the Clown, the demon from Stephen King’s “It” who feeds off your fears, over for a nice cup of tea. For example, if you’re obsessed with germs and contamination, then you have to abandon your compulsions and instead use public toilets and avoid repeatedly washing your hands. You choose to sit with the threat. Eventually, your brain habituates to the threat and is even bored by it, realizing there is nothing to fear.
Dr. Phillipson said people should first choose to forgive themselves for having O.C.D. If everyone had our misfiring brains, the whole world would behave exactly like us. Second, he advised against using negative imagery and instead welcoming our “best friend’s warning” but then choosing to ignore it. “The goal of the treatment is to make the thoughts irrelevant,” he said, “it’s not to make the thoughts go away.”
O.C.D. has exhausted me. I’m tired of suffering. I’m now doing exposure and response prevention, voluntarily exposing myself to my fears. It’s terrifying and often excruciating, like walking through a gauntlet of horrors without a shield or sword, armed only with belief and resolute conviction.
All the while, I’m working to abandon shame and guilt about my mental health disorder and to embrace the “best friend” I didn’t ask for.
Wajahat Ali (@WajahatAli) is a playwright, lawyer and contributing opinion writer.