My goal as a blogger is to write one long-form article for the blog each month. Occasionally, I will also post quotes I find valuable or share poems I have written. As you are no doubt aware, I failed to post anything in May (or June; technically this post counts for June since I started writing it two weeks ago). This wasn’t from a dearth of things to share; rather, it was because May for a teacher is basically insane. I simply ran out of mental energy. However, after nearly six weeks of summer vacation, I am refreshed and energized enough to write the article I have been trying to write for months. As you no doubt can tell from the title, this post is about the mental disorder that I have been diagnosed with: Obsessive Compulsive Disorder.
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If you’re like I was before I was diagnosed, then what you think of when you think of OCD is the caricature on TV and in movies who is a neat freak or obsessed with order or cleanliness in some way. However, OCD (which is frequently used in a casual/pejorative sense in our colloquial conversations) is not simply about being a neat freak. OCD is a mental disorder that causes intense suffering in those who have the misfortune to possess it.
The ‘O’ in OCD stands for “obsessive.” All varieties of OCD (and there are tons) begin with what are called obsessions, or thoughts/images/perceptions/feelings that take on a level of significance that they do not deserve. So, for example, imagine that you heard a window break in your house at 2 a.m. Imagine the adrenaline that would immediately pump through your body; your body would be primed to either fight off the threat, or to flee the threat (the fight or flight response). Now imagine that same response occurring whenever you had the thought that you might wreck your car today or that you might contract some weird disease after shaking someone’s hand. We all have these random thoughts, but a normal brain is able to screen the thought out, to put in a category called “eh, probably not something to worry about” and then to move on with whatever is next. Similarly, a normal brain is able to prioritize those thoughts that speak to real danger. If you see a rattlesnake or are about to rear-end another car, your brain begins screaming at you and the flight or fight response kicks in. The OCD brain, however, lacks this fundamental ability to put random/bizarre but innocuous thoughts in the “eh, probably not something to worry about” category. Someone who suffers from contamination OCD, for example, likely has the same thought about acquiring a weird disease when shaking someone’s hand, but instead of filing that away, it turns on the sirens and provokes the flight or fight response.
The ‘C’ in OCD stands for “compulsive.” All varieties of OCD follow the obsessions with compulsions. Compulsions are actions done by someone suffering from overwhelming obsessive thoughts in order to reduce the distress provoked by the obsession. So, someone with contamination OCD may compulsively wash her hands for minutes on end or a particular number of times. Completing the compulsion leads to a temporary reduction in the distress level of the sufferer. However, over time, the compulsions (which never satisfy for long; they are always growing) come to interrupt in serious ways the life of the sufferer. Someone who struggles with contamination OCD may find the repetitive hand-washing so disruptive and embarrassing that she refuses to go out to eat anymore because she is tired of spending 20 minutes in the bathroom after every meal while her family waits for her. Or someone whose obsessive thoughts lead her to constantly check whether the stove is turned off or the locks are locked on the doors to the house eventually quits her job 30 minutes away and takes one 5 minutes away because it is easier to rush home in the middle of the day to check.
The ‘D’ of course stands for “disorder.” If the obsessions and compulsions did not actually interfere with one’s life, then they wouldn’t be a problem. But people with OCD all have their lives significantly interrupted in some way, which is what causes them to seek therapy in the first place.
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I have written for years on this blog about my anxiety. I’ve even written about how I have been in therapy for my anxiety. But, as it turns out (and as I’ve suspected since as far back as March 2014), my anxiety is not simply the generalized kind where every day things are worried about excessively (though, I have that too). Rather, my most debilitating anxiety takes the form of OCD.
During Lent of this year I planned to fast from media of all kinds. This meant, among other things, turning off the podcasts that I listen to almost constantly when I am alone and not doing work that occupies my mind. When I did that, I noticed that my anxiety levels began to shoot up largely because of the influx of tons of bizarre and obsessive thoughts. When my mind wasn’t distracted, it naturally flagged for me every bizarre and sickening thing it could think of.
—————-For the record, the kinds of OCD that I suffer from the most are Harm OCD and Scrupulosity. Harm OCD is primarily contains as the obsessions thoughts about violence against others, especially people you love; it includes for me the thought that I will snap and go insane and commit violent acts. The compulsions run the gamut, but they essentially involve checking (where I ask someone whether they think I am violent or capable of violence), confessing the thought, compulsive/ritualistic prayer, and avoidance of people, media, or situations that are most likely to provoke the thoughts. Scrupulosity is about obsessive worry over “sins” one has committed. The compulsion is confession of those as a way to seek absolution or checking with someone to see whether the “sinful” act was, in fact, sinful. —————-
It became clear to me very quickly that there was something unique about my anxiety that went beyond mere worry. I sought out a Christian therapist who specializes in OCD. He diagnosed me and proposed a treatment plan. I just completed my fifteenth week of therapy.
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Treatment for someone with OCD involves Cognitive Behavioral Therapy (CBT), which is focused on changing the way we act and think about our actions. The specific form of CBT that is most effective with OCD is Exposure and Response Prevention (ERP). Essentially, the goal is to expose oneself to the obsessive thought and then to refuse to do the compulsion. Doing this slowly over time, and slowly ramping it up, is usually able to prevent the distress caused by the obsession from overtaking the self-control of the sufferer. By forcing your body and mind to confront your fear, you are able to conquer it. As your mind realizes that the things you feared are actually not very scary, it learns to not turn on the sirens every time that kind of random thought pops into your head. This process is essentially a kind of manual reboot of the brain. I have spent the last 15 weeks intentionally provoking my anxiety and refusing to do my compulsions. And while it has taken awhile, the amount of success I have seen has been amazing.
Furthermore, ERP is most effective when paired with an SSRI. SSRIs are a class of drugs that prevent the serotonin your body naturally produces from being reabsorbed as quickly. This leads to greater amounts of serotonin being present at any given time. Serotonin is a neurotransmitter that is associated with a general feeling of well-being. Upping serotonin levels is helpful for people like me with constant anxiety (both the generalized kind and the OCD specific kind) because it blunts the effect of the anxiety. So, about seven weeks in my therapist referred me to a psychiatrist who has put me on Zoloft. He’s been slowly upping the dose. At first I was very skeptical of taking medicine, but two and a half months in, it is clear the me that the medicine is very effective. I’ve seen large amounts of my low-level, generalized anxiety cut out and my anxiety responses to the obsessive thoughts appear to be reduced, thought not eliminated (of course). Actually, the Zoloft primarily means that it is less debilitating for me to get on with the work of doing the ERP. It is like an aid and sidekick to the cognitive and behavioral retraining I am engaged in.
As the quality of my day-to-day life has dramatically increased (for example, it used to be really difficult for me to keep the girls all day while Amanda worked because of thoughts I would have about snapping and hurting them somehow; now I very much enjoy getting the opportunity for one-on-one time with them!), I’ve also (because I’m me) spent a lot of time reflecting on some bigger questions about the ways that my OCD relates to my family, my faith, and my vocation. What follows is a tripartite reflection on those three areas in light of my OCD.
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In my understanding, the way that clinicians determine the severity of your OCD is by looking at the degree to which your life is affected by the obsessions/compulsions. For some unlucky people, the OCD makes work difficult, makes their marriage difficult, and prevents them, say, from driving. That is pretty severe. My OCD, however, primarily affects my home life. My HarmOCD is primarily rooted in thoughts of violence against my family. My Scrupulosity is largely rooted in fears that I have done something to offend my wife. To the degree, then, that I have successfully lessened both the compulsions and the anxiety that sits around these areas, I have found my life to be much better. But further, Amanda and I are discovering (we are also in a marriage class at church called Reengage) that my OCD has been a big factor in some of our marriage dysfunction. As I have learned to distinguish legitimate beliefs and desires from the false ones that stem from the OCD (for example, the OCD leads me to misread Amanda all of the time), our marriage has improved. And, maybe even more significantly, as the amount of time I spend every day internally focused on my intrusive thoughts decreases, I have found that I have been able to be significantly more present with my family than in the past. This has been a real boon to my relationships at home, but also in the classroom.
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As a teacher (especially as a teacher in a Classical and Christian school), I have thought a lot about what my experience of OCD says about the nature of the culture in which we currently find ourselves. Prior to robust consideration of my OCD, I was already skeptical of our culture which pours out affirmation and validation on any and every one. I am now doubly skeptical. As a teacher, one of my tasks is to help my students become resilient, to learn not to wilt under the disapproving gaze or comment of someone else. All that lavishing our children with unmerited praise does is it teaches them that if all is going well, they should be experiencing a steady stream of encouragement. The lack of this encouragement when kids enter the real world after their growing up years taught them to expect it (trophies for everyone!) has led to an uptick in anxiety disorders in general, and OCD in particular. To compound this problem, the ubiquitous adoption of social media by the kids I teach (and both older and younger than them) has allowed an unprecedented comparison game to be played by the most socially anxious people to have ever walked the earth. I do little things, of course. I hardly ever give extra credit, I have fairly strict standards about turning work in on time, I give praise for excellent work, but not for average work, etc. But the most important context at school that OCD has taught be about is the relationship between anxiety and sin. One of the hats that I wear is that I am the spiritual formation coordinator for the seventh grade. Like I have been with my therapy (which only works if one is highly motivated, if one has caught the vision for what could be and is willing to work hard), spiritual formation is only ultimately successful to the degree that one wants to want what is Good.
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The first sin was the sin of pride. Adam and Eve, following Satan’s example and advice, decided that they knew better than God did what was good for them. But the second sin, and all subsequent sins, were bigger than pride. Because, after the first sin, Death enters the world. The cosmos fractures and EVERYTHING starts to fall apart. The second law of thermodynamics–that within an isolated system the total entropy increases over time–was birthed in this moment. One aspect of the curse in Genesis 3 was that man must struggle to order his world; that the cosmos, while retaining a memory and echo of the divine music, will tend toward chaos without laborious intervention. The most obvious and most disturbing aspect of this progressive movement through time toward disorder is the movement that our bodies make toward death every moment of our lives. As we age, our bodies start to break down. And we, recognizing our impending deaths, seek to stave off that fate in a variety of ways.
The ancients (this is diverse; everyone from Greeks to Anglo-Saxons) sought to cheat death by living forever in memory. Post-mortem fame is a (paltry) way to cheat death. We even find this sentiment expressed in popular sayings today like “we rise again the faces of our children”–well, not really. Our children may remember us and may look like us, but we don’t, in any substantive way, survive death in them. Our culture in particular, but other cultures also throughout time, have tried to mitigate death by affirming the credo that “whoever dies with the most toys wins.” If life must end, then at least one can win at life by taking possession of life’s material goods. The Egyptian Pharaohs viewed life in this way; this is why they were buried with gold, jewels, and weapons–the accumulated wealth of this world would stand as a memorial to their greatness. Hedonism is another response. If this life is temporary, then one should make the most of it. Pursue pleasure as the ultimate goal. This life is thus like a vacation in which you give yourself permission to do whatever you want because you know you will have to return to the drudgery of normal life soon enough.
The first sin was a libertarian free choice–there was nothing in our first parents that predisposed them to sin. And who knows for how many eons they were tempted before they finally conceded their innocence? But once the choice was made, once Death cast its pall over human existence, we were fundamentally altered. Unlike Adam and Eve, we would begin life with the knowledge of our brokenness. Every action we took, every decision we made, would be done in response to the first fact of our existence: things (us included) don’t work the way they are supposed to. And because we can’t prevent our deaths, because things don’t work the way they are supposed to, we are afflicted with a kind of neurosis as the vantage point from which we react to the world.
If you will take just 30 seconds to reflect honestly on all the ways in which you are warped and broken, I’m sure you could come up with a fairly comprehensive list. Sin–the behavioral acting out of our neurosis–is a lot bigger than infractions against the Divine Law. Sin is anything that we do that disrupts God’s peace, that feeds the satanic chaos of our world. Much like those who have suffered at the hands of a violent man respond with violence, so do we, who have suffered at the hands of a broken world, respond with sin. My OCD is not my fault. It may have a genetic factors (or epigenetic factors) as well as environmental factors. But, whatever the cause, I didn’t choose this. But, when I operate out of my anxiety in ways that emotionally harm myself or others, that is my fault. It is not as basic as employing simple willpower, of course. Once I am in the grips of an anxiety attack, it is virtually impossible for me to reign myself in in any kind of a quick or easy manner. But, I can choose to put in the legwork on a day to day basis that I know will reduce my anxiety–the work my therapist has been teaching me to do as well as taking my medicine–and doing that is a matter of submitting to the guidance of the Holy Spirit in my heart.
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Almighty and eternal God, so draw our hearts to thee, so guide our minds, so fill our imaginations, so control our wills, that we may be wholly thine, utterly dedicated unto thee; and then use us, we pray thee, as thou wilt, and always to thy glory and the welfare of thy people; through our Lord and Savior Jesus Christ. Amen.