OBSESSIONAL THINKING

in OCD, GAD, HC, BDD, depression, panic etc.

‘The portion of the brain responsible for OCD functions very much on the same emotional level as that of a two-year old. Trying to reason with either in the throes of a tantrum is senseless.’
(Phillipson)

‘Attempts at reassurance inspire the brain to automatically scan for any possible exceptions.’
(Phillipson)

Depression: ‘a deficit in the ability to suppress unwanted thoughts’.
(Wenzlaff, Wegner and Roper)

‘…you are always more than your feelings. At most they indicate to you where you need to grow.’
(Craig Chalquist)

‘…depressed subjects were able to suppress unwanted negative thoughts by using negative thoughts as distractors. Depressed subjects found positive thought distractors a more reliable strategy, but negative distractors were used more often by these subjects as negative distractors were more accessible.’
(Wenzlaff, Wegner and Roper in Beyer and Hester)

‘Obsessive/compulsive disorder is now recognized as one of the most common causes of disability worldwide.’
(Khouzam)’

‘To the sufferer, obsessions are what is known as “ego-dystonic” thoughts, refrerring to the uncomfortable experience of such thoughts as imposed and intrusive. Obsessions are to ordinary worries as migraine is to ordinary tension headache.’
(Duckro & Williams)

‘Nearly 60% of patients who are diagnosed with OCD are later diagnosed with depression.’
(Robins and Regier)

Much of the following work on OCD is based on excellent articles by Steven Phillipson Ph.D; some of which (see references) can be viewed on http://www.ocdonline.com. This does not mean that Anxiety Care follows all the theory and therapeutic practices advocated by Doctor Phillipson; or that Doctor Phillipson, or any other website or author quoted, would agreed with all, or any, of the sentiments, beliefs and suggestions as detailed in this booklet.

OBSESSIONAL THINKING IN OCD

Obsessional thinking is part of all OC problems, but here we will be looking at obsessive thought where it plays a primary role in the disorder.

There appear to be several types of OCD. Those most commonly brought to Anxiety Care can be gathered together under three main headings: ‘Classical OCD’ which involves the performance of rituals to reduce anxiety and may cover a very wide range; ‘Over-responsibility and guilt OCD’ where sufferers feel they are responsible for the welfare of others and are plagued with guilt about their inability to be able to do this successfully, or to be worthy enough to do this; ‘Obsessional thinking OCD’ where there is no overt ritual, but the sufferer experiences intrusive, persistent and alarming thoughts that may seem to come from nowhere.

A person may have aspects of all three types, but it is likely that one particular area will predominate or draw more extreme emotional reactions that the rest, as in; ‘I don’t mind the endless hand washing so much, it’s the fear that my mother will die if I don’t pray in the right way that is the main problem.’

It seems reasonable to assume that where these versions of OCD vary most is within the causes. That is, ‘classical’ OCD might be to do with a chemical or neurological imbalance where personality or early learning has little to do with the condition. The other two might be seen as having a predominance of personality and perceptual traits, where the sufferer’s view of him- or herself is the main trigger. Here, an initial sensitivity, like a chemical imbalance, might have begun the process, but the person’s susceptibility to feelings of over responsibility, worthlessness or personal ‘evil’ has been the catalyst to make the disorder a major problem.

Anxiety Care sees a lot of ‘staining’ within anxiety disorder sufferers. That is, once it is integrated into a person’s belief system that he or she is of low value, incompetent or potentially evil, many areas of life become threatening or the source of hovering disaster as self-confidence dwindles and doubt spreads like a stain into many areas of thought and perception. As one client said: ‘Once I could look at a problem and see fifty ways to deal with it and I’d pick the best one. Now all I see is fifty ways to do it wrong.’

As Phillipson points out, there is a non-conscious part of the brain that sends information to the conscious part if it deems this information significant to the person’s needs or well-being. This process also involves trawling for information that might indirectly (sometimes very indirectly) have pertinence to the person’s continued welfare. This process is a reflexive one and beyond our control – we cannot stop the information trickling (or blasting) through - but we do have a choice as to how we deal with it when it arrives.

Most people, those without obsessional thinking problems, discard the irrelevant and useless data and process only that part of it that is pertinent to their current situation. However, we all have preoccupations that might ‘colour’ this processing. For example, a charity client who has a problem with blood is so tuned in to the word that he is able to detect it being voiced amid several conversations in a crowded room. This can be likened to the ability we all have to respond to our names when spoken nearby, even by someone we were not consciously aware of as being within our hearing range, or even as being present at all.

‘…the part of the brain responsible for anxiety is not a thinking part, but only understands the experience of danger.’
(Phillipson)

This information-sorting part of the brain seems to be on duty at all times and certainly picks up a lot more information than we are consciously aware of. If we are tuned to a particular way of thinking or an area of current-sensitivity (like someone else’s footsteps on a lonely pathway at night, or the sound of a speeding car when we are crossing an apparently empty road) we are naturally going to process anything, like the above, that impinges on this.

Linking this to the way the brain can throw up tenuous connections, we are prone to jumping to wrong or ambivalent conclusions. This can be demonstrated by a method sometimes used in OCD groups. The leader says a word such as ‘jam’ and asks members to think about it and any thoughts it leads too, for thirty seconds. At the end of this time, ‘jam’ might have taken some people through scones, summer teas and happy holiday memories, while another is in a traffic jams on the M25 again and still another is cursing the cupboard door that never opens properly and wondering if he can afford a new kitchen.

In the above, no really emotive connections occurred, but if a person is in the habit of seeing him- or herself as out of control, weak, or ‘evil’ the summer holidays may be stained with self-contempt at not being able to sit on grass or sand for fear of contamination; the traffic jam underlines once again this person’s fear of killing somebody with his car; and the kitchen takes the last person back to fears of the knives in that kitchen drawer. In the latter situations, the super-sensitivity would probably take the sufferers back very quickly to frightening thoughts that grew out of one innocuous word.

‘There is no evidence that people who develop anxiety disorders change their basic thought patterns. What does appear to change is the intensity of the experience associated with what is perceived to be threatening thoughts.’
(Phillipson)

There are probably many areas and levels of ‘thinking’ with at least one having responsibility for holding every-day knowledge that we are not even aware generates thought. This knowledge might be our name, when asked, or which tool suits which job in our regular employment. In these cases and in many others, we don’t consciously think about the response, it is ‘just there’ in our minds when we need it. This is a very useful mental skill as it saves a lot of effort.

However, non-useful items can also be added to this internal list of time-savers – such as an obsessive response to an outside stimulation. Here it might become automatic, ‘without thought’, to avoid all pregnant or otherwise large women; to avoid all mirrors and reflecting surfaces; to count the pedestrians that one’s car passes.   All these have been ‘responses without thought’ brought to Anxiety Care in the past year.

In these situations the stimulation has begun to generate an automatic response that might then be as hard to ‘forget’ as one’s own name. It also has the added anti-benefit of seeming to be as natural and necessary as are all the good automatic responses that make life simpler. Once this is explained, it can help sufferers to understand that the obsessive reaction is not normal and acceptable, but a dysfunctional response that has just ‘sneaked in’ among the useful ones. It is not ‘bad’ it just is. Whether it is a feeling of being out of control, potentially evil, responsible for other peoples welfare, or being guilty of all unsolved crimes in the region, it is just activity in the brain with no moral overtones or rationality.

Our need to make sense of the thoughts and feelings is part of the fear, the drive to understand and to be in control of our lives. It is nothing to do with the reality of the fears, because they have no reality.

When a sufferer is willing to believe that he or she is a bad person, that ‘only someone thoroughly evil could think these things’, the problem of ‘bad’ thoughts escalates and the effort to force them away again is intensified. However, trying to force a thought away or making efforts to avoid it’s recurrence – by staying away from situation that might cause it, hiding sharp objects, pills and potions etc – is far worse than useless as these huge efforts only ensure that the thoughts will grow stronger. Our anxiety keeps it’s mental fingers on our reactions at all times; it does not differentiate between real and imagined danger, its not bright enough for that, it just experiences the blast of feelings and labels this perception as super-serious and to be watched out for at all times. In such a situation, the more a person tries to hide and/or force the thoughts away, the stronger they become.

As with all anxiety conditions, the trick is not in reducing the times anxiety hits, it is reducing the response to these hits. Anyone who is undertaking a recovery programme will, inevitably, encounter the fears more often, which will involve more occasions on which anxiety blasts. This is an absolute requirement of the self-treatment. Anyone who judges relief by the amount of avoidance that he or she is able to undertake and the number of thoughts avoided is not recovering at all. Such a person is ensuring that the OCD owns them.

This can be very difficult to accept when these thoughts are hurtling around in one’s mind for many hours each day, or are hovering, apparently ready to ‘strike’, at the slightest jolt or reference to the feared situation.

When this occurs, it is tempting to try to ‘think the problem through’. That is, on the basic assumption that there just has to be a reason to be thinking like this, the person starts to work on detecting this reason. This is invariably disastrous because these thoughts don’t have a rational basis – they are obsessive and that is all they are. Once a person starts to look inside themselves for the ‘badness at the root of it all’ they will inevitably find something, because we all have areas within us that do not stand up well to close scrutiny.

We are all the product of everything we have ever thought and done and a solid proportion of this will be uncomfortable. Just looking back at ourselves as infants, children and adolescents, using young people of these ages that we know now, shows how self-involved, unkind and downright cruel we must have been at times. As one of Anxiety Care’s counsellors says, we all understand how a two-year old responds and accept it, but if that two-year old mind was put in an adult body, that person would be classed as dangerously deranged at the very least. So we all control the infant-inside, but it is still there.

‘’The more you laugh at the OCD, the more disrespect you give it. Hence, the less power it has.’
(Phillipson)

It simply isn’t possible to go through life without enduring malicious and self-serving thoughts. It is not possible to have children without becoming angry with them, resentful or, occasionally, wishing they weren’t around. We are emotionally involved with the people in our lives that we care about, but this caring doesn’t mean unbroken, unconditional love. It most certainly doesn’t mean that the slightest negative thought about these individuals is a betrayal and proves that we are ‘bad’. If anything, it proves that we are human and good at understanding people, because if we believe some individual is pure as the driven snow and totally perfect in every way, we are just showing that we are not good judges of people and situations, which is not a useful trait for an adult.

Take one of the most common fears of obsessive new mothers: holding a vulnerable baby and imagining dropping it on the hard ground. This is not a wish to perform the act, it is one’s mind flagging up the truth that babies are delicate and easily hurt; it is a thought about ‘not dropping it’, not a wish to harm the child. If we had no such thoughts, we might treat the baby like a bag of potatoes and forget our responsibilities and…woops! Most people experience the horrendous thought, see the tragedy in their minds, shudder and let it go. Obsessive people don’t. For the obsessive thinker, each shocking thought adds to the belief that he or she is ‘bad’ or out of control, or a potential monster. And these thoughts will be far worse if a tiny part of the mother mentioned above is angry, tired, fed-up and the thought of harm to the baby (and maybe resultant peace and quiet) wasn’t a total negativity for a fractional moment.

A charity worker states that, many years ago, his father used to spend night after night carrying his sister, the youngest child, around the first floor bedroom when her teeth were giving her a great deal of pain; and that after nearly forty-eight hours without sleep, he longed to toss the baby out of the window; that was all he could think about. This became a family joke, often repeated with relish over the subsequent forty years. At no time was there excessive guilt about the expressed feelings, and none was ever expected.

However, if these thoughts trigger terrifying responses about ‘personal evil’ and are then rattling round in the mind for hours each day, this person not only feels horror and fear but begins to think that he or she must be going insane. For most people, hovering insanity would prove that he or she is indeed almost ready to kill that baby; that he or she must be on guard against thoughts because they will soon reach a point where they are irresistible. This just isn’t true.

Charity workers who have been studying this field for more than twenty years can assure readers that there has never been one documented case when an obsessive actually carried out the feared harm. One doctor, when discussing this problem on a radio programme actually laughed at the question. He said that people with obsessive fear of their thoughts are literally the last people in the world to do such things. They have so many blocks and terrors between them and causing harm that it would be virtually impossible for them to carry out the actions.

This applies, in Anxiety Care’s experience, to both conscious and unconscious harm. People simply don’t drop poison into the baby’s milk or ground glass in their partner’s dinner by accident. Once the thought has occurred while undertaking food preparation, the chemical shock to the body and mind ensures that not only does the thought reoccur each time a similar action is undertaken (as we remember things best in the situation we learnt them, particularly if the learning was flagged up as vitally important which would be the case with obsessive thought), but that ‘casual’ or ‘thoughtless’ actions in that area become physically and mentally impossible. Basically, we are constitutionally incapable of performing the murderous act when it has been reinforced internally as hugely important not to. This would be in the same category as a bomb disposal expert forgetting he was in the process of defusing a bomb and whacking it with a hammer. It just doesn’t happen.

However, like the bomb disposal expert, nobody will give you a guarantee that it won’t happen – nothing is beyond possibility. As with everything in life, the obsessive person has to understand the likelihood of the consequences of any action. Getting out of bed in the morning can be dangerous - carpets fray, pets get under foot, bleary and only half awake we are not at our most careful. Having a shower or bath can be very dangerous – slippery surfaces, slippery soap, bath water deep enough to drown in, drowsiness, physical contortions to reach everything. Knowing the risks, what sensible person gets out of bed, or showers or bathes? The answer is, of course, all of us, because we have dealt with the dangers in our younger days and trust ourselves to do all this competently with the dangers stacked away neatly as understood but statistically viable.

We do not worry about something like this that has entered our thought processes as another time-saver that does not need conscious consideration, unless there is some special reason to do so, such as, with bathing or showering, an infirmity or bodily injury that requires special care.

This is just what happens in obsessional thinking. Our minds are telling us that there are ‘special/dangerous circumstances’ to consider and we are nor programmed to ignore such alarm bells. Absolute commitment and instant response to anxiety or fear-raising situations is a life-preserving trait that has served our small, soft bodied, blunt toothed, clawless species well for hundreds of thousands of years. It is a survival trait better than razor teeth and needle claws. As this is the case, we just cannot, genetically, ignore the signals it gives us.

So, there is no point trying to force the thoughts away, they don’t respond to that, they can’t. The trick is to process them differently.

‘An ordinary intrusive thought may be experienced as annoying or “weird”, but an obsession becomes an experience which is feared.’
(Duckro & Williams)

As Stout says, we have to accept all our thoughts – not that they necessarily tell us anything about ourselves, but that they exist and they are ours. They can be left at a pre-reflective stage, that is, with no interpretation or association with other things, or we can become involved in thinking about them. This is the quandary many obsessive thinkers find themselves in. ‘Good’ and ‘normal’ thoughts are dealt with at a pre-reflective stage, not given ‘thinking time’ – so a smile from another person is just accepted as a non-interpreted event and passes out our mind with barely a ripple. However, a frown from this person might mean (to the obsessive thinker) that his or her ‘badness’ is detected. A flash of anxiety and we begin to analyse the look and search within ourselves for the thought or action that ‘must’ have drawn it. In this way, normal and pleasant input that draws a simple recognition that it has occurred but no real reflective time, never balances the ruminations and anxiety that accompany any input and corresponding thought that we interpret as dangerous. In this way we come to perceive our world as full of danger and threat.

So the negative process begins as Stout describes for all thoughts: we identify the topic of the thought; we search our memories to determine whether we traditionally ‘like or dislike’ that topic. Based on the liking or disliking we experience desire or aversion (accept or avoid); we have a will to act on this desire; we work out through experience, reflex or intuition how to secure a successful completion of the activity the thought generated; we make a physical action to complete the task. This might by at a mindless, unconscious level (like scratching an itch) or consciously as the beginning of a major and life changing activity.

As Stout continues, and as all obsessive thinkers should grasp, once we are aware of the thought process we can begin to have an effect on it. This is best done at the point where we have ‘a will to act’ in the stages described above.

For the obsessive, this means he or she does not have to follow habit or a chronic, negative process. The obsessive can choose not to act as fear demands, or to act by putting the thought to one side with no real response. The person with obsessive thinking problems tends to experience the originating thought, with all its hangers-on of past misery, failure and fear, and then to try solve it, or placate it with ritual, or he or she tries to escape. In this way, the obsessive thinker becomes entangled with the thought as rumination. It cannot be solved or avoided but this does not stop the obsessive thinker trying. One charity client has been spending up to fourteen hours a day for the last eighteen years, trying to think his way out of this disorder. He has recently been persuaded to try another way.

This is not unusual and it does not reflect on a person’s intelligence or common sense. In fact, some highly intelligent people are suffering to some degree because of their mental abilities. In their experience, their unpleasant lives show nothing of value but their intelligence – that is, this intelligence is all they perceive they have to prove that they are viable human beings.

In this situation it is very easy to persuade oneself that the proper use of this intelligence is the only way out. The problem is, they are working with damaged tools. Their mind has decided that two and two is five, or the measure they are using is calibrated wrong. In these instances, the math or logic that follows the initial mistake may be impeccable, but it is inevitably leading to failure and will always be a failure because it is based on a false premise. Obsessive people cannot think their way out of their problems by the power of intellect alone.

‘When your brain sees that you are no longer running from the feared topics, a long-term consequence is that it will generally not bother transmitting the warning.’
(Phillipson)

For those who do not give mental activity great value, it is still very tempting to try to think oneself out of the problem or to become involved in mental ritual to damp down the fear. The greatest temptation of all is to give the thoughts credit. That is, the obsessive thinker cannot accept that a thought can be based in nothing of significance, that it is just a chemical or neurological misfire. Instead, this person clings to the view that any thought must signify a coming act, or at least a willingness or desire to perform such an act in the future.

‘…cross-national epidemiological studies have established that the proportion of cases of obsessive-compulsive disorder(OCD) in the community reporting obsessions only may be…up to 50-60%.’
(Weissman et al)

Within the groups, we suggest that anyone with a pictorial imagination can place themselves in any situation it is possible for them to imagine: this is better known as fantasy. There is nothing so wonderful or so disgusting that we cannot picture ourselves as undertaking it if we are so inclined. There are obviously areas that we avoid for social or cultural or family reasons, things that would be too distressing or embarrassing or illegal, or which would have too much of an impact on our fragile vision of ‘the self’ to consider consciously (see ‘sexual fears’).

However, many obsessive thinkers have very rigid parameters of thought. For example, one client was terrified of stabbing her young son and locked away all knives and forced the thoughts of knives from her head when they threatened to enter as they frequently did because she had flagged up the thought as so important. However, she had no worries about harming him in any other way and was comfortably able to imagine herself lighting a match and holding it near his duvet while he slept in the certain knowledge that she would never do this in real life.

That kind of process demonstrates the irrationality of obsessive thought and the tortuous flexibility of anxiety that can so irritate outsiders. That is, to non-sufferers, one is either murderous or one is not. They would find it hard to come to terms with someone who only perceives herself as dangerous in certain areas.   They find it next to impossible to comprehend that a person can come to an arrangement with their obsessive thinking. That is, the fear of poisoning the baby’s milk has to stop when the obsessive thinker is down to the last few spoonfuls of powder (after throwing out the rest) because otherwise the baby goes hungry. The man afraid of contamination by proximity to gas pipes if he comes within a hundred feet of one outside, has to live near them in his own house because he has no other option.

To many non-sufferers this ‘proves’ that the obsessive person’s problems are not genuine. Unfortunately, it sometimes does the same for the sufferer. The doubt that even this living hell is not ‘real’ only makes the problem worse. Believing the problem ‘silly’ or ‘pathetic’ just undermines the will to counter it, for what is the point of trying to oppose something that doesn’t really exist?

Sufferers, carers and others who come in contact with obsessional thinking or, in fact, any severe anxiety disorder, have to understand that the problem will take up as much space in one’s life as it is allowed, and that it is pressing against these borders all the time. It has to be understood that such anxiety isn’t a rigid entity, but flexible and insidious. Most people have to maintain a certain level of ‘liveableness’ just to maintain their current place in the world. If circumstances were different they would love to throw out all clothes after one wear, dump the new carpet after the dog defecated on it, never again touch a door handle or any liquid or solid that could conceivably cause harm to another living creature; but this just isn’t possible for ordinary people. So sufferers come to an accommodation with their lives and their problem.

This is part of ‘balance’ which was discussed at length in ‘I know I’ve got to do it myself, but…?’ All our lives are about balance; whether or not we get out of a warm bed on a cold morning to go to work – comfort and much needed sleep against unemployment. Pigging out on adored chocolate – oral pleasure against weight gain and spots. Whether we throw yet another dinner in the bin for fear we have poisoned it – relief from anxiety against a partner’s condemnation and/or rage for wasting ill afforded money.

Seriousness (weight) of balances may be enormously different from case to case, the only requirement is that, in each individual case, one side just out weights the other. In many cases what constitutes the balance may be incomprehensible or invisible to outsiders. For example, in the case of a friend of the charity’s who is crippled with arthritis of the knees. Whether she drinks a cup of tea or not is much more to do with her ability to endure the pain of climbing the stairs to her lavatory in an hour’s time than how thirsty she is. This particular balance will only change when her need for liquid becomes more ‘weighty’ than her reluctance to endure severe pain; and this is a very simple, physical case, nowhere near as complicated (and probably humiliating which adds even more weight to the balance) as the choices of balance that an obsessive thinker must face many times every day.

For example, a female client is always late for work. Her OCD makes it extremely difficult for her to leave the house. When she needs to leave she is in front of her household appliances, checking and checking again, and cannot bring herself to go out through the front door. This situation continues until the balance of anxiety about leaving is out-weighed by the anxiety about losing her job. She is incapable of going out of the door until the need is extreme and this happens every working day. Living at this sort of ‘crisis’ level is very uncomfortable, exhausting and stressful, but many OCD sufferers do something like this every day of their lives.

This struggle, chipping away at the person’s dignity and self-esteem, is usually a lone battle fought out of sight (at least out of emotional sight) of even the closest and most loved family member. Sufferers feel lonely, isolated and usually freakish and sub-human. Very rarely do people suffering in this way understand the enormous victory they achieve every time they resist a compulsion or an obsessive thought.

One of the most important points Phillipson makes in ‘When Seeing Is Not Believing’ is that relief-seeking, looking for a way out from a perceived dangerous situation, is absolutely basic to human beings. It is a biologically programmed response to look for a solution, to obtain comfort and seek relief, when the anxiety centre of the brain (the amygdala) is activated. This means that the therapeutic requirement to resist this drive is going against nature.

This is small comfort of course. However, it does mean that the shame and guilt often voiced by the obsessive about being ‘weak’, ‘pathetic’ ‘not as strong as other people’ is misplaced at best. Anxiety Care workers agree that the continual battle they witness as sufferers struggle against this destructive disorder, is the site of more courage and determination than most people see in their lifetimes.

As said elsewhere and in various ways in this booklet, the answer, the way to deal with obsessive thinking, is to retrain the mind. It will never be possible to stop the amygdala responding to threat. If it were possible, we wouldn’t survive long as individuals; accident would claim us. In fact, were it possible, the species would have died out aeons ago. Anxiety as said before, is an essential survival trait.

The trick is to believe that the drive to find relief in ritual or thought is a way deeper into trouble and not the answer under any circumstances.

Many obsessive thinkers lose their place in the endless stream of thought that passes through the brain. That is, they lose the ability to differentiate between a random cognitive response that might have been fuelled by any number of physical, situational and biochemical activities, and their real selves. They simply begin to believe that everything that goes through the mind is significant. Even if, as is common, obsessives understand that such thoughts, pre-OCD, were ignored with a shudder at worst and at best were barely acknowledged and instantly forgotten, this often has no bearing on the way such thoughts are dealt with currently.

It should not be assumed, as many sufferers do, that obsessive thought is some new and strange way of thinking and the precursor to insanity or development into some kind of homicidal or sexual monster. As Phillipson says, OCD is an anxiety disorder, not a thought disorder. The vast majority of people think in just the same way as the obsessive; they simply do not give credit to the dross and the scary stuff – they accept it as the way the mind works and as having no pertinence to their character or cultural normality. They are fortunate in that the part of their brain that deals with anxiety does not label many pointless and irrelevant thoughts as vitally important, and/or the thinking part of their brain does not process every negative thought or impulse as a sign of badness.

The problem is, once doubt has entered the equation, obsessive people tend to try to be ‘super straight’; As with many areas of life, the greater the doubt about the self in certain areas, the greater the need to be seen, internally and externally, as culturally normal in these areas; (Which is almost invariably far to the ferocious right of being acceptably, humanly, ‘normal’). The sensitised obsessive begins to resist any thought that could not be voiced to his or her maiden aunt or the local bobby; and it is one short step from there to assuming that everyone else, not suffering in this way, must have similar internal cognitive processes that, by their obvious comfort with their minds, means they never think ‘bad thoughts’ at all.

This has the dual ‘benefit’ of making the sufferer a freak in his or her own mind, potentially a dangerous one, and therefore capable of virtually anything unless thoughts are rigorously controlled and guarded against.

‘People who start to listen to themselves usually encounter those painful emotions that lie just under the surface of consciousness: anger, shame, guilt, loneliness, depression, sadness, confusion…this is normal, so don’t let it scare you.’
(Craig Chalquist)

Everyone represses the bad stuff. Repression is an unconscious mental process that pushes all the unbearably painful, frightening, shameful and otherwise personally unacceptable feelings out of the conscious mind, sometimes together with relevant memories (Molnos). As discussed in the booklet ‘Guilt and Shame’ these feelings and memories arise from conflict between our basic needs and drives and our internalised moral and social norms and standards (what we want against what family and culture demand). Trouble is, these denied events and feelings slosh around in our unconscious and continue to have an effect on our behaviour and our perceptions.

Most of us are vaguely aware of this psychological theory and many will recall the intense debate a few years ago about repressed memories of childhood, the supposed world-wide satanic abuse cults and the subsequent ‘false memory syndrome’ work. This hardly furthered the cause of science or improved the human condition, but it left many people with part-understood beliefs about the subconscious and the power of the mind. All of this fuels the obsessive thinker’s belief that he or she must control and explore thought.

However, as stated, most thought-stream activity richly deserves to be ignored – it has little or no value and is purely a response to outside stimulation that touches off irrelevant firings in the mind according to that person’s current physical and emotional condition: in short, a reflex.

‘It is important to note that one’s thought content and one’s genuine beliefs can be very different. People are not responsible for the ideas that occur to them through automatic cognitive processes’.
(Phillipson)

SEXUAL DIFFICULTIES

Sexuality is a prime example. Human beings have a broad, life-long, band of sexual interest that is artificially held to narrow, culturally imposed parameters in most countries. According to Allie, the western cultures were born out of ancient religions, pre-Judaism, Islam and Christianity, that held sexuality to be obscene and a curse; and the modern religions have integrated the stance, if not the actual rules, into their belief systems.

Fear and guilt is a good way to control a population and religious leaders of every epoch have not been slow in understanding this. So, religious teachings have always, notoriously, tried to control sexuality, but even the most prudish amongst us would (hopefully) find some of the Christian restriction on sex between married people, of a few centuries ago, laughable although they were culturally accepted at the time. Unfortunately, suppression of natural drives tends to distort their expression and even generates increases in them, which is something that these original teachers did not take into account.

As we all know, there are still many taboos and rules; some make sense, some don’t and ‘normality’ is often more to do with geography, social class and the century we are living in than anything more basic to the human condition. Unfortunately, we all tend to see the restrictions our particular culture places on us as ‘absolutely and immovably correct’; as if these rules were a law of nature rather than an artifice put up by people who felt they had the right to control others, and had a personal agenda for this control, and who (probably) integrated their own sexual hang-ups into the laws.

Within the last fifty years, homosexuality, for example, has changed from ‘official’ diagnosis as a mental illness to being, in the west at least, an acceptable (if still controlled to some extent) life style. So what changed? Did an immutable law of nature change or was it the laws of people catching up with reality? And why are there so many laws against so many sexual activities? If all this sexuality was really beyond the desires of normal people, as the media would have us believe (while lip-smacking over it), why the great need to control these ‘non-problems’ in the general population?

‘Inferiority was highly correlated with intrusive thoughts about perfectionism and sexuality.’
(Yao et al)

   Men’s thoughts in particular easily drift into sexual avenues and the vast majority of normal men would admit, if they were honest, that a huge range of potential partners has drawn their sexual interest. Paedophilia is the current ‘shock/horror’ topic of choice and an interest that virtually all men would hotly deny.

It has been stated that calling somebody a paedophile is now the worst insult any person can lay on another and the hunt for transgressors is reaching a point in the UK that hasn’t been equalled since the hunt for communists in the 50’s in America and the witch hunts of this country in the sixteenth and seventeenth centuries.

‘…a sizeable minority of men in normal populations who have not molested children may exhibit pedophilic fantasies and arousal.’
(Nagayama Hall et al.)

An American survey (Briere & Runtz) has shown that over 20% of the normal male American college student subjects of this survey had had sexual feelings for children and that some would have involved themselves in a sexual relationship with a child if this were legal or if they knew they would not be found out.

Bradford, discussing the Crepault and Couture research, states that over 60% of their male subjects reported heterosexual paedophilic fantasies. And anecdotal and research evidence drawn from a wide range of sources, (notably Nagayama Hall et al.) suggests that occasional (not central) sexual interest in children is quite common in normal men and, at least from Anxiety Care’s experience, is far from being the sign of ‘degenerative monsterism’ that the media would have us believe.

This is not to say that adult/child sexual acts should be encouraged or condoned, or that any non-consensual sex is acceptable – we are talking about interest, sometimes fleeting and, in today’s cultural climate, almost invariably alarming and/or instantly repressed by the thinker.

Where does this leave normal men? We are the product of all our thoughts and experiences. Most of us will have memories of being sexually attracted, maybe totally smitten, in our school days, by classmates or other children in the school we attended or the clubs we frequented – teens and sub-teens. This is a normal part of development and these feelings reduce on sexual maturity, but our abilities to feel sexual interest in these areas is still within our experience and so part of ourselves.

Are we not to allow ourselves to think of this with pleasure as adults? Does being culturally correct mean excising these memories and being afraid because we once felt interest in (and still recall with nostalgic pleasure) someone who was below the age of consent, and this might mean the beginning of the slippery, slope to perversion? Does being attracted to a girl the day before her sixteenth birthday, make one a pervert, while being attracted to her the next day makes one a red blooded male?

As another example, the age of consent varies widely among American States, so it could be argued that it would be technically possible to be a normal male one side of a US road and a registerable pervert on the other after certain sexual activity.

‘The fact that millions of people believe a lie does not make the lie a truth.’
(Erich Fromm)

We cannot police our thoughts to extremes. We all have an inbuilt block against incestuous thoughts and activity as this is not socially or genetically useful to us as a species, although there is a very grey area at that time when we are ‘in love’ with our infant children; and more than one woman has suffered agonises of horror and self-loathing at being aroused by a suckling baby, which in itself can be just a physiological response.

Most of us also have culturally induced blocks against illegal activity of extreme sorts, such as rape (although research suggests that what constitutes rape in the minds of men and youths can vary hugely and not only from culture to culture). However, outside the more stringent and obvious rules, men’s feelings of affection and admiration easily slip over into sexual interest, the more sexually arouseable the man, the greater the chance of inappropriate sexual interest. This doesn’t mean anything. The idea that a momentary sexual awareness of a child or an ‘illegal’ teenager means an inevitable decline into molestation is ludicrous, but it is still being voiced by people who should know better and who want us all to police our thoughts – which might itself be seen as the ultimate, solicited self-abuse.

Anxiety Care has encountered several young men who are terrified of their sexuality. The problem is, one cannot be sexually aroused and very anxious at the same time, these responses are physiologically exclusive. So, if a man is in the habit of being made anxious by his sexual thoughts, it can become a chronic habit so that he cannot then even be aroused by what he might perceive as ‘normal’ sexual thoughts. Here lies the situation where young men trying to think ‘wholesome and normal’ sexual thoughts about women find they are not aroused because the chronic anxiety has sneaked in too, and so they then dive into the further terrifying thought that this must mean they are homosexual – more anxiety and a further guarantee that all or most future sexual thinking will involve a level of anxiety which will reduce sexual arousal, which will concentrate the thinking on homosexuality or other sexual fears, which…etc.

Some young men coming to the charity have found it impossible to think of a potential partner in a sexual way at all; they maintain such a close guard on their thinking that anything beyond the fantasy of a chaste kiss or hand-holding rings alarm bells. They are then trapped by their thoughts. If they have also adhered to the foolish teaching that masturbation is sinful or unhealthy, (ignoring or unaware of the fact that most people do it, and of the growing teaching that it is healthy and useful) and allow themselves no sexual expression, they are building up towards major problems.

Sexuality is part of everyone and its expression is a requirement that the body does not give up on easily. This does not mean imposing oneself on an unwilling partner, or forcing unwanted sexual acts on an otherwise consenting partner in the name of ‘good health’. It does mean that sex wants to express itself and won’t be denied. In the young (and sometimes the not so young) building up ‘a head of steam’ so to speak in the name of abstinence, leads to sexual expression at some point in spite of, not because of ones needs, and this can sometimes feel uncontrollable emotionally.

In the subsequent post-orgasmic state, the person is then free to be horrified at his or her ‘terrible uncontrollable lusts’, usually when the relief was self-induced and so no happy partner available to reassure him or her. This simply feeds into the obsessive fear of sexuality and the OC’s willingness to believe that he or she is a monster just waiting to be let loose on the world.

This inevitably aggravates the condition and the scene is then set for years of sexual doubt and mental and social isolation. Unfortunately, sexual obsession of this kind invariably leads to extra preoccupation with sex and a growing belief by this person that he or she is ‘sex-mad’ if not just plain mad.

Research suggests that normal men think of sex several times an hour. If a sexually obsessed OC is like other obsessive thinkers, he or she might be spending the greater part of the day ruminating about the problem – statistically, ten or more hours a day obsessing virtually full-time is not unusual for obsessive thinkers over thoughts that are not as persistent as sex. What then would this prove to someone afraid of his or her sexuality? Inevitably that he or she is potentially a sex criminal or so wanton as to be fit only for exclusion from civilised company. In this way, isolation and fear grows, and being afraid to talk about it ensures that the problem never finds a reasonable level within the thought processes and continually refuels itself. Linking this to the impossibility of becoming sexually aroused while extremely anxious, can lead to a person searching deeper and deeper within the self for his or her sexuality.

‘…one’s thought processes are altered or affected by the presence of shame.’
(Tangey, Wagner & Gramzow)

As has been said before, there are areas within all of us that are not comfortable to look at and our sexuality is right up there with the best of them. Emotionally healthy people realise that sexual fantasy need have little or nothing to do with a person’s actual sexual activity. Research says that both men and women have rape fantasies and many others that the law would frown on, or actually prosecute a person for performing in real life. These are the expression of a wish to be sexual (Fox) not a desire to actually perform the acts. Being attracted to the femininity or masculinity in another person of the same sex, does not necessarily involve ones sexual orientation at all, it can be simply an expression of feelings.

In fact it might be true to say that the more emotionally healthy the person, the broader the range of fantasies; but as the OC thinker is more interested in comfort and safety than health, it is almost guaranteed that his or her range or sexual fantasy would be heavily restricted. Digging deep to find arousal, even subconsciously, while armed with a mental stick to beat off everything that couldn’t be recounted to the maiden aunt, is a sure recipe for disaster. This will be additionally painful for the person who does not realise that his or her sexual fantasies were often formed in early childhood (Fox). As the focus here would probably involve immediate family it is then quite normal to find adults with incestuous or infant-like fantasies.

Sexual obsession, focusing on personal needs and fears, very easily translates the subject of desire into an object. That is, sexuality stops being an integral part of a full and rounded life and becomes life’s main focus where potential partners are not seen as such but as ways to relieve tension; crudely, for a male, as receptacles, for the totally obsessed, receptacles to avoid. With both situations, the partner is no longer a human being but another obsessional act.

Unfortunately, this state of mental affairs is common with OCD of all kinds. Obsessional problems easily present as another form of addiction – the driving need for relief at any cost. Family, friends and partners easily translate into just another resource for avoiding the overwhelming obsessional anxiety. This is not hard to understand – objectifying everything in the service of OCD – for anyone who has had the problem or who has had to live with a person suffering in this way. OCD easily becomes the only reality because it has its poisonous tentacles in every aspect of the sufferer’s daily life; just like addiction to proscribed drugs.

‘…one of the mind’s functions is to create habits…’
(James Harvey Stout)

It is like the master/slave syndrome. A master need know nothing about the slave, but the slave, to survive, has to know as much about the master’s needs as possible: In fact to be able to sense and meet those needs before the master himself is even totally aware of them. So it can be with OCD. Everything easily becomes lumped into two camps: obsessive problems and the rest. When mental survival seems to be in doubt, nothing else has real value. This is not a conscious choice of course. Like the master/slave situation, it can just be a reality of life.

Translated into a person’s sexual existence, it then becomes hard to view partners as people with needs and desires of their own. Orgasm may be the culmination of successful arousal against threatening anxiety, or proof that feared abnormality is not true, for a while. It can be (for men) a reinforcement of the belief that the sufferer is still a red blooded male or still able to perform ‘marital duties’. There may be very little space left for considering the partner’s wants and needs.

‘Within the fabric of each human being lies a basic drive to resolve emotional conflict when it reaches a heightened level.’
(Phillipson)

On the subject of proving masculinity, it is common to find male OCD sufferers very focused on their ability to have orgasms. As said elsewhere, when a man begins to doubt his masculine traits, not necessarily his sexuality, but his standing as a man among men, (common with men who suffer with anxiety disorders) sexual expression is often viewed as the fundamental proof of manliness. In this situation, it is not uncommon to find male sufferers giving up medicines such as SRI’s that have had a profoundly beneficial effect on their disorder, because their ability to reach orgasm has been restricted by it.

This might seem ridiculous to the observer (or the long suffering sexual partner) but it is another fact of obsessive life and one that has to be taken into consideration. Men with obsessions often feel less than manly, if not downright sub-standard and anything that holds their masculinity together in their own minds is powerful and necessary if this insidious disorder is not to own them.

Psychotherapy, as in an exploration of what constitutes manliness, might be in order here. However there is a more mundane response where this lack of orgasm has become a problem. Research suggests that it is possible to have a ‘medication holiday’ sometimes – reducing the dosage or leaving it off altogether before a weekend for instance – but this has to be done carefully and with the prescribing physicians guidance and approval. As with all areas in OCD, the thinking processes, used properly, will prevail over the powerful, but basically non-thinking obsessional part of the brain.

‘Analysts have actually known that their form of therapy is of no value to people with OCD for many years.’
(McKay)

CONTAMINATION AND THOUGHTS

According to McKay, the most common form of OCD is that to do with contamination fears. Obsessional thinking is obviously involved here as the sufferer, by definition, will be involved in irrational thoughts concerning cleanliness. McKay defines contamination as: ‘…a pervasive sense of having some undesirable object(s) still on one’s body, even after washing.’ He further states that: ‘ Many sufferers…report a ‘radioactivity effect’ such that mere exposure or incidental contacts with an identified contaminant results in total contamination.’

As with all obsessions, the more the rituals, in this case washing, are undertaken, the more this ‘proves’ to the mind that the perceived danger was real and the response vital.

When people fall into the belief pattern that only total cleanliness is acceptable, they have entered an area where the fear never ends; because there is always room for doubt and the mind is always keeping a look out for dangers: That open window, did germs fly in as I finished? Did I brush against that wall/towel rail/sink? How can I be absolutely sure I did not? The answer is, you cannot and you never ever will be certain of perfect cleanliness because this is an impossibility.

One charity client reports that this latter fear was always catching him out. As he was nearing a conclusion to the washing, he would sometimes ‘lose perspective’; that is, as he could see his hands with the wall/floor/sink behind them, they appeared to be touching one or other of these objects. To prove they were not, he had to move closer to the one focused on this time. Inevitably, this movement made him feel that maybe now he was touching, so he had to move again…etc. Eventually he would come in contact with the feared object and, mortified, the washing rituals had to begin all over again.

This client also demonstrated another area of the OC’s intolerance of uncertainty. He was incapable of accepting a ‘maybe’. Either planning an outing with friends or checking with someone that an activity had been completed properly, he had to have an absolute ‘yes’ or ‘no’ and it mattered little which it was. In this way, friends often stayed away because they knew that he could not accept tentative arrangements, and seeking reassurance on completions often lead to anger as few people would give a 100% guarantee that something was ‘clean’ or ‘safe’. A near-rational twist to the latter was that when he encountered people who patronised him by giving total guarantees in areas that, in more rational moments, he knew could not be true, he felt humiliated and betrayed and a need to find more ’trustworthy’ contacts for next time.

This kind of uncertainty is different from ‘pure’ obsessive thinking in that it is more an intolerance of doubt and, in this case, a fear of illness than a belief in being responsible for the safety of others, or being guilt based.

As McKay details, obsessional thinking becomes involved when a person with contamination problems fears harming others as in making them ill or even killing them with a disease he or she has been carrying inadvertently on body or clothing. It might also come into play where the person has irrational beliefs about cleanliness, that it is possible to be totally ‘clean’ and germ free, for example, or that everyone has a responsibility to try to reach this state of being. In this type of contamination problem, when starting recovery work, it would probably be of more value to deal with ideas and beliefs in this region before starting a recovery programme based on a simple reduction of the length of time involved in decontaminating.

‘Today, with or without a belief in religion and the supernatural, the notion of “evil thoughts” and “evil emotions” is overpoweringly pervasive in our culture. Its impact on mental health is devastating. On the one hand, it generates guilt; on the other, it sabotages men’s efforts at self-awareness. One cannot pursue self-investigation with a gun aimed at one’s head.’
(Branden)

Where washing or other forms of decontaminating are used to deal with ‘bad’ or ‘evil’ thoughts, this is almost invariably based in feelings of guilt. One client described his feelings of sexual guilt as presenting in the form of fears that words would flow out of his fingertips onto paper or other ink-friendly surfaces describing his ‘evil’ when he was not vigilant. This was never delusional; that is, he never really believed it, but based his finger licking response as being ‘better safe than sorry’. This might be described as another version of being unable to accept the slightest possibility of being visibly culpable linked to extreme guilt feelings.

While touching on the subject of delusions, it should be understood that it is not only the very seriously mentally ill who suffer in this way. ‘Normal’ people can also be delusional (Sheringham). In the description of work on the subject, Sheringham states: ‘Analysis of the frequency of delusions showed that nearly 10% of ‘healthy’ people had more delusional beliefs than the average score from someone with severe psychotic illness.’

In fact, looking at the range of human beliefs, it might be reasonable to suggest that we are all delusional about not being delusional.

‘When one gives in to a ritual, the brain’s sensitivity to the perceived threat is increased.’
(Phillipson)

McKay makes a very valuable final point in his excellent article when he points out that: ‘sometimes individuals simply cannot effectively engage in treatment related exercises. This problem manifests itself frequently when the fear associated with engaging in behavioural exercises is too high to be tolerated.’

As he mentions, and as charity workers would verify, therapists who insist on a programme that the client cannot maintain because of intolerable anxiety, are probably not the therapists that the person should have been talking to in the first place. Which doesn’t offer much comfort if they are the only ones available via the local NHS.

‘Although many sufferers recover from contamination OC, it is widely acknowledged that special attention must be paid to matters relating to staying recovered.’
(McKay)

RESPONSIBILITY AND GUILT

Aspects of this type of OCD were looked at in the booklet in this series, ‘Guilt and Shame’ however, here, we will be looking at obsessive problems where guilt and other responses aggravate feelings of responsibility.

The ‘greyness’ of this region manifests itself in washing and decontaminating generally. That is, Anxiety Care has encountered sufferers who wash both to reduce their fear of being contaminated and to prevent contamination occurring to others by their ‘negligence’. And as has been detailed above, clients with strong guilt feelings are very prone to excessive washing.

Phillipson & Gold in, ‘Beyond a Reasonable Doubt’, suggest that this type of OCD is distinguished from the others by the presence of guilt which is probably associated with the belief that a person’s worth as an individual is linked to the way he or she responds to such OC triggers.

In the charity’s experience, this can be a bit ‘chicken and egg-ish’; that is, clients have sometimes expressed confusion over whether their worry is to do with social concern, or anxiety/guilt over being responsible for the well-being of others, or fear that once they have become part of the problem (interacting with a ‘dangerous’ object) they will be perceived as responsible for the future harm potential of it.

‘I have yet to know a person with OCD to have been ruminating over a threat involving anxiety or guilt, which turned out to have any realistic significance.’
(Phillipson)

This was well demonstrated by a client who once became ‘stuck’ beside a broken bottle at a kerbside. He explained that he had pushed it off the pathway with his foot in order to prevent a child or other vulnerable individual tripping and hurting themselves on it, and this had been done with little anxiety or thought of any sort. He had then begun to worry about cars or buses that might puncture a tyre as they came into the kerb, but was prevented from placing the bottle in a nearby bin for fear that one of the vagrants in the area would harm himself when searching the bin for useables. He spent nearly twenty minutes agonising over his actions before he was able to walk (very anxiously) away.

He saw his intervention as making him part of the problem, which would not have occurred if he had simply walked past and left the glass where it was. During discussion he expressed the feeling that his fear of being responsible and open to punishment if detected, (so culpable might have been a better word) had quickly begun to outweigh his social concern for the safety of passers-by; that during the twenty minutes of rumination and regret he would have dealt with the guilt over an injured child in preference to the current feelings and the misery of culpability-doubt that plagued him for several hours afterwards.

This left the client unhappy with himself, putting his needs above those of a child, and regretting that this had proved to him that such a situation was possible. This client had been a life-long OC presenting with several variations of the disorder through contamination, guilt and checking ritual. He also had self-worth doubts that were simply aggravated by this episode.

This man is far from the only client who has presented with what might be called under-responsibility OCD. Over the years several checkers have expressed an inability to maintain their own households due to an inability to take responsibility for appliances, doors, windows etc. In most cases this has been linked to the person’s self-worth but in a flexible way where cognitive responses have been amenable to making responsibility someone else’s problem. (‘If you are last out and the door is left open, and we are burgled, it’s your fault, not mine.’)

It is debatable if this aspect of over-responsibility can be classed as just another area of the type of OCD, regarding obsessional thinking, we are discussing here. For example, a client who is finding it increasingly difficult to drive for fear of harming pedestrians and other road users, has no such fear when his partner, arguably a less able driver, is in control of the vehicle in these same areas. In such a situation, the feelings of responsibility are certainly irrational as, statistically, his partner is probably more likely to cause harm that he is. However, it is in his actions and the response to these actions he feels at risk, not within the rational area of deciding who is better qualified to do a certain job – which a person without OC problems would (probably) take more into consideration.

There might, of course, be an argument in this particular case for stating that the driver was being rational in that his aberrant behaviour while driving (looking in the mirrors too much for bodies behind him) made his theoretically less able partner a safer choice behind the wheel. This argument itself would fall down when discussing too much mirror work with this man as he would not see it as a problem, just a safeguard. So his focus of harm is on personal culpability, not the harm itself.

This area of over/under responsibility might be better viewed as an aspect of General Anxiety Disorder (GAD) where the overwhelming fear of life pressures and decisions leads to irrational behaviour; This is demonstrated by a client, working in a senior management post, who allowed a less able junior to make poor decisions on his behalf, secure in the irrational belief that he was then not responsible for the subsequent problems.

‘He who despises himself still respects himself as someone who despises.’
(Nietzsche)

Phillipson & Gold describe the definition of responsibility OCD persuasively: that someone suffering in this way might be seen as feeling that he or she is able to cause harm by wishing it (even subconsciously), or can cause harm through their own ability to contaminate others unless scrupulous cleansing is undertaken. Basically, that he or she has too much ability to impact on another’s life, or has too much responsibility for protecting others. They state that: ‘this hyper-sensitivity to possible threats to others’ well-being is a feature that all individuals with Responsibility OC share.’

The area of under-responsibility is a difficult one with obsessional thinking. Experience within the charity suggests that those with an over developed feeling of self-doubt or hovering culpability are not prone to laying this off onto ‘power figures’ such as charity workers. That is, while doctors and psychotherapists might experience the situation where they are perceived as having given permission to the sufferer to give up responsibility (any disaster is then the ‘professionals’ fault if he or she has ‘forced’ the sufferer to give up some area of irrational, protective behaviour.); This has never happened within Anxiety Care.

No clients presenting with this type of obsessional thinking have shown the slightest desire to lay off their fears onto the worker, although this has often been discussed, or given any hint that such a proposition was even feasible. All have demonstrated that their feelings of responsibility were far more personal than that, very much locked in to their value as people or a need to believe that their irrational thinking demonstrated extreme caring and a proof of love.

There might be a case here for saying that such clients are not looking for relief and escape but a confirmation that their obsessive thinking is legitimate. Here, simple exposure work alone, attempting to reduce anxiety and dread by accepting the chance that harm will occur if ritual is not performed, is very unlikely to work without concurrent cognitive therapy and assistance with thought and self-talk changing.

‘Since the body and brain can periodically misfire and create unexplained feeling of peril, coping with and accepting these emotional events is more important than ensuring that they do not return or attempting to escape from them.’
(Phillipson)

As an example, one client has presented with a belief that he should be willing to sacrifice his life in order to save any other living person from death. When challenged on the reality of this belief, he does not respond with an extreme religious or humanist posture that might, just, be arguable, but with the feeling that he could not deal with the knowledge that by his inaction he allowed another person to die.

This is to do with anxiety and an unwillingness to experience it, perhaps also a very low self-valuation. It is not a laudable reverence for all life – it is never as simple as that. However, this does not (usually) prevent the person suffering in this way from hijacking a humanist position and presenting his or her obsession as a worthy trait. As obsessive thinkers are prone to thinking round the edges of a problem, involving themselves with the minutiae of the situation rather than the cold, straight facts, this is sometimes difficult to deal with and can lead to a great deal of directionless discussion.

We all need to understand what is going on in our lives, as has been discussed previously. It is a species trait. And the obsessive thinker tries more than most to make sense of his or her world: anything that reduces anxiety is grasped like the proverbial straw. In such a situation, it is common for a sufferer to find (and cling too) a coping technique, or therapeutic suggestion, that works once or twice, something along the lines of accepting the thought as ‘just a thought’ not a reflection of one’s life style or value as a person.

The problem is, if this is taken on in response to an outsider’s urging, much of the ‘power’ liberated might be that of the outsider. That is, the sufferer might be carried away by this outsider’s conviction or silver tongue on only a temporary basis.

‘…it may be comforting (not therapeutic) to know that the content of one’s obsessions does not characterize one’s true identity.’
(Phillipson)

Then often occurs the problem that relief is experienced without inner conviction that this is the way forward. The mantra, ‘It’s just a thought, it means nothing’, or whatever is used, becomes just more noise with no real belief behind it. Then a double problem is in place for the person does not experience much further relief, because the words are not really believed, and this person begins to search wildly for some other combination of thought and/or outside person to repeat the earlier ‘success’.

In this way, meaningless mantras are voiced, ‘proving’, by their failure, that accepting the anxiety is not the right approach and that some other outside force or power-person is needed to take the pain away. This stands alongside the willingness to give up responsibility for the problem as in the mantra: ‘It is not me, it is my OCD!’

While the latter may be useful as in the sufferer realising that he or she is experiencing erroneous responses on the basis of false perceptions of anxiety-borne information, it is more often used by people who are dissociating themselves from their thoughts. That is: ‘these are not my thoughts, they belong to the disease OCD which is inhabiting my brain.’

This frequently brings comfort but it is not therapeutically sound. All thoughts have to be accepted by the obsessive thinker if recovery is going to happen. These thoughts belong to this person. They are the result of a lifetime’s thinking, together with perceptions that have involved little thought. They are the result of every single external and internal action that has ever been processed by this body’s five senses. If they are distanced, if they are viewed as some malevolent invasion that has no part of the person they are ‘preying on’, then they can truly be seen as having power of their own. In such a case it is then one short step to believing that obsessional thoughts will lead to anti-social or illegal actions. Why shouldn’t they if they are not part of the reasonable and rational OC person and are taken on face value?

This can be a difficult concept to grasp, particularly if the person with obsessional problems is in the habit of repressing uncomfortable thoughts and feelings, or simply in the habit of denying the parts of him- or herself that are not liked. It is much more comfortable to see the things we hate in ourselves in other people. How much more reasonable then to view obsessive thoughts as a totally separate attack of misfiring brain chemicals that have no place in the sufferers mind. Like measles or a head cold, it could be seen as something that has come from outside and has invaded our body and we can do nothing about it but take medication and wait until it goes away.

When problems of responsibility are involved, it can be that much easier to see the obsessive thinking as an outside force. The weight of the responsibility can be huge; nobody suffering in this way ever takes pleasure from it even when, as said, they confuse it with a positive character trait. In such a situation, believing that the wounding or exhausting obsessional thoughts are not real but simply an illness, they lose some of their power to frighten, but they gain a disturbing independence that easily feeds in to feelings of being out of control should this be an aspect of the sufferer’s disorder.

‘Personal constructs are conclusions, convictions, attitudes…anything conceptual we use to make sense of our world. When rigid they become dogmatic filters over the eyes of awareness, thereby blocking our openness to new experiences, viewpoints, meanings. Allowing constructs to be ‘what I think or value or believe just now’, isn’t being wishy-washy; rather it’s a mature recognition that constructs are always working hypotheses constructed by an imperfect being who is always open to new learnings.’
(Chalquist)

AGGRESSION

One charity client, has become an expert at multi-layered thinking, having put literally thousands of hours to the service of his obsessions. He has become confused in that a thought might lead to a feeling, that might lead to a memory, that might lead to an impulse, that might...it goes on and on. His mind is an area of huge sensitivity where no thought is casual. Everything that comes into his mind is filtered through obsessive doubt.

This kind of situation easily lends itself to the belief that these thoughts are not of the person enduring them, but a disease-borne invasion that has to be repelled.   As with any attacker that is seen as monstrously strong and potentially shattering, the subject is primed to fight back rather than to welcome. Unfortunately, trying to force away obsessive thoughts is a very good way to ensure their continuation and growth.

At the same time, very few normal people can accomodate the belief that something that is perceived as so malign and inimical to life can be internal without it also being the sign of imminent mental collapse.

Accepting that the thoughts are one’s own is a leap of faith that may be beyond many people starting out to work through a recovery programme. This is OK. As previously stated, a recovery programme has to be based in achievable steps, and the first one might be simply accepting the possibility that the above may be correct: ‘all thoughts are mine’; not necessarily swallowing it whole but entertaining enough doubt in personal perception to allow the belief room to grow.

As mentioned previously, this can be extraordinarily hard. Most severe obsessive thinkers will perceive all their energy as going into simply functioning, putting one mental foot in front of the other. If total denial of frightening thought is an energy saving technique in this process, then opening oneself up to more work and anxiety by accepting the truth about thoughts may be viewed as totally impossible. This is OK too.

All anyone can expect is that the sufferer will be willing to negotiate around this theory once the energy levels are better. As said, if the thoughts appear, to the OC, to be monstrously malign with a power of their own, it will be even more frightening to accept that they come from inside. This can then generate the situation where the sufferer accepts half of the theory. That is, he or she has been dealing (albeit badly) with the thoughts, using the comforting belief that they are just expressions of disease, like a runny nose or a measles spot, not part of the person; where watchfulness and caution are all that is needed to keep the disease from making the sufferer harm or molest others.

If a persuasive therapist (of any sort: professional or lay) over-turns this belief and manages to drive home the idea of personal responsibility for thought without helping to instil a belief that such thoughts are not precursors to actions, the sufferer is in trouble. In such a situation, the OC might feel as if he or she has been cut adrift as a bomb just waiting to explode. The thoughts have not lost their ominous threatening power within the sufferer, they have just been identified as a sign that this person truly is evil or a predatory monster.

‘Paradoxically, the chances of obtaining relief is increased the less one seeks it out.’
(Phillipson)

Someone with low self-esteem or a more than normally imperfect view of his or her ability to control personal actions might find a sort of perverse comfort in being self-identified as truly as bad as he or she fears. Hovering doubt is corrosive and debilitating – ‘am I, am I not?’ Anxiety wants to become fear or a resolution, so even a terrible truth is still a truth that leaves no more anxiety-raising doubt.

In such a situation, the misery and simple time consumption involved in multi-layered or questioning thought is gone and, with extreme obsessive thinking, any relief, even bad relief, is good news. The OC accepts the thoughts as belonging to him- or herself, but misses the qualifier that it is the perception of these thoughts, not the thoughts themselves that is doing all the damage.

As mentioned previously in this booklet and elsewhere, the simple power of such thinking can sweep a person away. One client suffering from extreme fears of harming and killing people, feels that he has to be aware of every thought at every moment, and be able to ‘play back’ every second of every activity. His perception is that, if he cannot recall literally every movement he has made during the day, the ‘blank spots’ are the times when he ‘blacked out’ and killed someone.

He does not subscribe to the belief that everyone has ‘blank spots’: that none of us can recall every action we take in a day because it is not physiologically necessary for us as a species to be able to do this under normal circumstances. He does acknowledge that, as a motorist pre-OCD, he did drive to places without conscious thought sometimes and was surprised when he arrived (we all have this auto-pilot capacity), but he cannot equate this with current circumstances; So any moment of relaxation is followed by checking his earlier progress for bodies when the terror hits again. He accepts that his extreme awareness of every painful second means that he should remember selecting and hiding the killing knife. And he is not divorced enough from reality to believe that the police have overlooked bodies strewn around the shopping precinct he frequents; but his hugely obsessive thoughts seek other answers – conspiracy, people protecting him – rather than the simple truth that these are brain misfires on top of a super-sensitivity to personal ‘evil’.

When a person is that afraid of his mind and it’s capacity to make him perform actions that are totally against his nature, it is then probably not a good idea to insist, at this time, that all thoughts are accepted as personal property. He is probably incapable of understanding that we all have violent thoughts and dismiss them (or even enjoy them). Any one of us who has been humiliated by another person, or who is looking after a child that is trying our patience to extremes, might find relief in fantasising about a physical response. However, the obsessive thinkers will have a whole stream of thought scenarios ready to click in as soon as the originating thought occurs. That is, for example, the urge to smack the naughty child’s bottom instantly develops into thoughts and images of losing control and battering the child to death. This is nothing to do with the person’s nature or violence levels; it is because such a thought process is scored into the brain by endless repetition, waiting only to fit round the next suitable generating thought.

We all have these ‘thought scenarios’ at some level. They might be viewed as fantasies if they were enjoyed. Some ‘normal’ people are appalled by their sudden flashes of rage and vengeance-thoughts and, as mentioned elsewhere, work hard at legitimising them; but they are part of life for all of us: we get angry and want to lash out, it is there within us as a species.

One charity counsellor who specialises in obsessive thinking problems states that he has a whole range of such scenarios of varying strengths that pop up in face of certain stimuli. For example, one client of his has a particularly colourful thought response whenever she hears a certain type of observation from friends or strangers. Whenever he hears this type of response himself, he thinks of the client and what she would have thought. He then does an internal shrug and lets the thoughts go. He can do this because he does not see the responding obsessive thought as significant, just as an understandable part of a thinking process; it was his thought, but the way it was processed depended on outside sources which had nothing to do with his value as a person.

This counsellor states that he has had many such scenarios in the past, generated by clients, but that all of them ‘dried up and blew away’ for lack of reinforcement. That is, as they were not personally important to him or relevant to ongoing mental activity they had no significance past an interesting event and disappeared completely once a particular client had gone.

This is common to all thoughts. Every thought leaves a certain residue in our minds according to its relevance – and this might be a good or bad relevance. This is part of our continuing self-education and growth. If we did not learn and change slightly all the time and have fractionally different responses due to this residue, we would adhere to outmoded responses and not develop into well-rounded adults always willing to learn.

However, when a thought is hugely terrifying, its residue is deep and muddy with a direct link to fear scenarios. So a thought of punching an ill mannered lout in the street, far from giving a certain relief to frustration, grows into thoughts of murder and graphic internal pictures of blood, guilt, family grief, trial and imprisonment. The OC is almost instantly a shaking wreck and the lout swaggers smugly away oblivious to the misery he has caused.

Such scenarios would naturally lead to extreme sensitivity to any angry thought and a need to monitor all strong emotion. This would inevitably grow over time into monitoring all thought so that even an interaction involving a friend, if not carefully thought through, has terrifying potential.

As with the client described above, who fears killing people, there are no safe moments when he is in a severely aroused obsessive state. Experience tells him that even the quiet times between ‘attacks’ are dangerous because, once the obsession has risen again, he will have needed to remember every action during that time of normality in order to prove to the roaring anxiety inside that he can account for every movement.   That direction is towards exhaustion, huge pain and, often, a driving need for peace that sometimes only suicide seems able to promise.

‘Various parts of the brain present different levels of priorities or experiences of urgency. This duplicity of experience explains a key phenomenon: as the primitive part of the brain is misfiring biologically, the reasonable neo-cortex is confused by the false alarm.’
(Phillipson)

A sad point within this, relating to recovery, is that some OC’s, totally sensitised to their aggression, find it very difficult to take an aggressive stance towards their disorder once recovery is underway. That is, it can be important to be able to say to oneself in the situation above; “Yes, I probably killed that yob and buried him with all the others I’ve killed this week! Roll on the next one!’’ This is therapeutically healthy, but might be realistic for someone who has extreme anxiety in this area. An inability to indulge in such ‘gallows humour’ should not be looked on, by the sufferer, as yet another failure.

On this subject, it is also important to take an aggressive stance towards the thought processes during recovery if at all possible. This could involve encouraging the thoughts to do their worst and even looking for more extreme versions of the familiar, fear filled process as a pre-emptive strike – bringing them on deliberately before the thought scenario can click in – in order to circumvent the process. The part of the brain that wants us to feel extremely uncomfortable until we have dealt with the perceived threat then has nothing to do and the process of breaking down its stranglehold on our lives has begun.

The problem is, as mentioned, that when potential aggression has become terrifying to us, it is extremely hard to generate its chemical help to work against the disorder. Someone suffering in this way, as just said, might be so sensitised to aggressive feelings that he or she finds it impossible to use the same feelings to counter the obsessions. Then might be the time to talk through the whole idea of anger and rage with someone familiar with this field, outside the process of habituation and response prevention.

However, from Anxiety Care’s experience, this does not have to become a problem, as many clients seem to have been able to differentiate between obsessive fear of aggression and the more natural thoughts in this area. In fact, one client with extreme fears around violence was able to marshal much of the force involved to stand against the terrors. Basically he urged them to come and get him, which they naturally did not. He had managed to turn the focus of the violence away from the perceived targets (his children) onto himself which he was much more comfortable with. This did not solve the problem entirely, but his confidence grew enormously and he soon became able to push the thoughts away as ‘just inappropriate thoughts’ brought on by familiar thought scenarios, not the precursor to imminent murder.

This is a powerful tool within recovery – understanding that we have the ability to control our responses and move towards a positive outcome.

‘It is common for people to experience a diminution in the urgency to perform a ritual once they accept their willing collaboration and make the active choice to give in.’
(Phillipson)

COLLABORATION AND LIVING ON THE EDGE

A client who has had OCD since childhood reports that he finds it difficult to differentiate between relief gained by deciding to collaborate with the disorder (ritualise) and relief gained by deciding not to ritualise. He states that, at his worst, he would give in instantly when the urge to ritualise and check arose, even if this meant waiting for a period of hours (if he was away from home) until he could perform the calming rituals; just surrendering in his head seemed to be enough to reduce the anxiety to tolerable levels.

At one point, when he was away from home for over a week, he states that the need to check something that could only be done in his home simply stayed with him for that period, albeit at a less than critical level, until he was able to perform the ritual.

Now that he resists ritualising, he states that the equal and opposite decision not to collaborate gives him very much the same relief, but now he feels that this is a positive step rather than the humiliating surrender he saw his previous collaboration as being. “It owned me!” He said.

This client also developed a coping technique for long-term problems that involved him deciding that ‘anyone can handle this for a month’. He states that once the agony of indecision – should he or shouldn’t he – was removed from the equation he was able to look at the problem rationally. At the end of the month, he would decide whether or not to give in to the demands again and, invariably gave himself another month. In this way he states that he ‘staggered through six years, damn near successfully!’

The fact that collaboration brings relief can work disastrously to keep people trapped by OCD forever. This is sometimes seen within the charity where people have great responsibilities. Their perception is that they absolutely have to remain functioning so anything that allows this has to be accepted. Usually it is difficult to fault the perception if a person has large financial and family responsibilities and feels that he or she might ‘crack up’ and be unable to work and so lose everything if the disorder is opposed.

This enters the area of having enough ‘slack’ in one’s life to deal with trauma. Charity workers tell all clients that they have to ‘get away from the edge’. That if you live your OC life to the limit, metaphorically walking on a cliff edge, sooner or later that edge will crumble or something, or someone, will give you a push.

We all need enough emotional and psychical reserves to deal with the pushes that life inevitably gives us but, as discussed elsewhere, many OC’s perceive themselves as working flat out just to stay in one place, functioning as an adult with responsibilities. If this is the personal reality, it is exceedingly difficult to persuade people to oppose the disorder (additional and frightening activity) and so risk losing a great deal.

One client reported that he had a major argument with a therapist because he felt unable to accept the risk of contaminating certain irreplaceable work-related objects. He said that he could accept that this was the next logical step in his recovery programme as far as the therapist was concerned, but it presented to him as far too dangerous with the loss at failure far too great.

This particular situation seems more to do with the therapist’s poor perception of a structured hierarchy than anything else, but it does point up that many people who have to earn a living, feel that they cannot oppose OCD, this ‘ultimate blackmailer’, for fear of pushing themselves over the edge.

As said, charity workers try to help clients work out techniques to get away from the edge in such cases and remain very aware that capitulation, allowing the obsessions their way, is always a hovering alternative option when relief is perceived as essential. Far better to work at obtaining breathing space, slack, whatever an individual wants to call it, so that the problem can be dealt with, not integrated into the rest of one’s life; but to do this it has to be seen as a viable option.

Sometimes, medication is the only way. This does not necessarily reduce the perceived problems, but it usually enables the sufferer to see that he or she is able to invest some level of energy in resistance without the ‘certainty’ of failure. It gives a more accurate view of the true size of the difficulties. These might not take on the aspect of a ‘paper tiger’, but they might present as a less sprightly tiger than they appeared to be before.

‘It is critical to understand that relief-seeking is actually a biologically programmed response characteristic of human beings.’
(Phillipson)

MAGICAL THINKING

Magical thinking is something we all do as children where wishes and reality can be indistinguishable. Chalquist sees aspects of this in adult relationships when we can swing between idealizing and despising a partner, expecting them to be perfect and totally nurturing and in touch with what we want from them; or totally dependant on us emotionally.

Molnos describes it as believing: ‘if I only think it strongly enough it will happen.’ And Penzel says that magic and superstition are as old as humanity and ‘represent a way for us to try to explain the normally unexplainable, and to try to control the seemingly uncontrollable’. The later might be a good definition of magical thinking within OCD.

James Alcock takes the position that some level of magical thinking is inevitable for all of us. He states that as evolution selects on the basis of reproductive success rather than with regard to reason or truth, it is sometimes more survival-friendly to think magically, to run on the basis of an erroneous magical coupling – ‘a rustling bush always means a large carnivore is hiding in it’ – than to hang around in total, rational control and find out for certain what that bush contains.

Of course, if such magical attribution stops the creature or person from ever approaching a bush again and the fruit and boughs of such bushes are a major source of food and protection, then this individual will similarly not live long. Therein lies the process of rationality and logic and plain ‘chance taking’ that has to be in existence to dilute our tendencies to think in extremes.

‘…memory is a constructive process rather than a literal rendering of past experience, and memories are subject to serious biases and distortions.’
(Alcock)

It is true however, as Alcock points out, that we all have a tendency to link events and infer that the first caused the second, even when it does not; also that this situation is aggravated when the originating event is heavily loaded with emotion and finding a cause would offer relief from co-current anxiety.

Alcock states that ‘because of the nervous system architecture…we are born to magical thinking.’ The trick is, of course, to learn to put it aside as mentioned above. One excellent way is to accept the need for the magical thinking; that it serves a purpose by allowing us to feel in charge of our lives and fills the species-need to understand everything in our environment, but to put it aside anyway. Part of that response must always be to understand how easy it is for all of us to take a position and then dismiss all evidence to the contrary.

‘It is impossible to compute the magnitude of the disaster, the wreckage of human lives, produced by the belief that desires and emotions can be commanded in and out of existence by an act of will.’
(Branden)

Within many people’s perception, there truly is a yawning chasm waiting to open up if they dare to give up a set of beliefs or even one huge magical one, and enter the no-mans-land of seeking out new knowledge. The problem is, of course, that we are very hesitant to give up a belief if it works well enough to let us function, and at the same time offers that shadowy threat, as described above, of ignorance and fear if we do give it up. This ignorance and fear, as we tread between what we know and what we want to know, is common to everyone. Most people, not just obsessive thinkers, perceive giving up long-held beliefs as dangerous.

As Alcock points out, we all learn best from the association of two significant events – such as touching a hot stove and feeling pain. If we touch that stove again when it is cold, this does not mean we unlearn the first response as the cold touch has no significant effect on us; so the two events are not closely linked. This works just as well (or badly) with magical thought. Once we have reduced intolerable emotion by an undoing or placating thought, we are very likely to repeat this behaviour.

As we all have areas of life that we have to take on trust – religious beliefs being the main one for many people – we learn, as we grow up to bring a certain flexibility to words and events presented to us. Very few people can honestly say that there are not areas of their lives that they take on trust rather than on concrete proof of its truth or otherwise. Once this belief is established it will enter our belief system, rational or not, and we will tend to accumulate other information, from outside sources, sorting carefully, to confirm this. The stronger the emotion, (maybe very frightening feelings in OCD), the more unshakable the belief may become.

Many severe obsessives feel a very extreme form of this; that they are out of control and are experiencing a driving need to regain that which they perceive they have lost. This might or might not be a conscious process, but any compulsion will have an element of relief about its completion. However, magical thinking has a special place all its own.

‘…it is one of the great ironies of OCD…that it is in attempting to escape the anxiety- or guilt-producing thoughts that the greatest damage is done, because the thoughts themselves, while unpleasant, are survivable, whereas the attempt to escape – that is, the ritual – distorts the sufferer’s behaviour and affects his or her ability to function in the world.’
(Phillipson & Gold)

As Penzel says, with regard to magical and non-magical thinking in OCD, if the thought process was just one that resulted in very negative expectation from any action, it would be a ‘normal’ morbid thought. Magical thinking is quite different in that it attributes some form of unseen but very strong power to its occurrence. Sufferers may, for example, believe (as does one charity client) that simply thinking about a certain disease has the power to cause its occurrence within her or within a loved one. When such a thought occurs, this client feels compelled to perform ‘undoing’ rituals that might be described as a prayer or even a spell. She feels she has to repeat certain ‘healthy words’ a specific number of times, and if she is interrupted (by outsiders or her own wandering thoughts) she has to start all over again.

Another client has to perform certain actions in a precise form in order to ensure his family’s continuing health; and a third feels compelled to perform a complicated, mental ‘undoing’ ritual of words and numbers if he has sexual thoughts, in order to ensure that he does not stray beyond personally acceptable (very restrictive) sexual bounds; all of it mental rather than physical.

As will be noted, this ‘morbid-or-magical‘ thinking can be a grey area where a compulsion might quickly leap from ‘simple’ horror at one’s personal vileness, to a need to detoxify the thought by ritual.

When an OC thinker feels out of control and potentially dangerous, the belief that he or she can block the consequences of this perceived evil by some form of compulsive action might obviously be viewed as of great benefit. This can be understood with regard to a client who has problems with thoughts about harming his children when he sees a sharp knife. His response is a huge and overwhelming feeling of dread and horror with little attached thought. In his situation, the ability to ‘undo’ the feeling by some kind of magical thought would obviously meet the body’s need to reduce tension. He doesn’t do this and many clients and contacts in this general type of situation also show no inclination to adopt magical thinking as a response.

It is difficult to ascertain whether magical thinking is part of the disorder’s impact or part of the sufferer’s response to it. It might be logical to suggest that magical thinking, being part of all of us in our very earliest years, is a ‘last resort’ for anyone feeling totally out of control or helpless.

It might, of course be viewed as quite the opposite. The infant perceives everything as relating directly to him or her – the baby causes everything to happen in its own version of the world. Many OC’s coming to Anxiety Care would view this as the ultimate horror; it might be said that their need to have no responsibility is the opposite pole to the magical thinker who sees everything (within certain parameters) as his or her causation. Their ‘last resort’ would be to totally deny any kind or responsibility and ability to have impact on an obsessively perceived situation.

‘It is not that magical thinkers totally believe in their magic. They don’t. They do, however, experience serious doubts and need encouragement to take the risks necessary to see that their beliefs aren’t justified.’
(Penzel)

It is not always possible to work out where the ‘normal’ obsessive thought response such as: ‘that was a terrible thought; only a worthless/evil person could have thought it’, stops and magical thinking begins. Some people use counting or the repetition of certain words, (mantras almost) to ease internal pressure. One client reported that thoughts he perceived as evil could be balanced by certain magical movements in another area. That is, when the originating thought response to outside stimulation (a pretty girl) made him feel like a potential rapist, his magical responses that (to him) kept his family healthy, which he would then do, proved his level of sensitivity and caring, which balanced the originating perception that he was a bad person. In this way he was able to keep two sorts of obsessive thought active and ensure his continuing dysfunction as a person.

Penzel offers a list of magical behaviours he has encountered which might be useful to readers and these are as follows:

·         Repetitive praying or crossing oneself

·         Counting up to or beyond certain numbers

·         Reciting or thinking of certain words, names, sounds, images phrases or numbers

·         Moving one’s body or gesturing in a special way

·         Stepping in special ways or on special spots when walking

·         Washing off bad ideas or thoughts

·         Arranging objects or possessions in a special order

·         Performing physical actions in reverse

·         Thinking thoughts in reverse

·         Repeating behaviour a special number of times, or an odd or even number of times

·         Performing behaviours at special times or on particular dates

·         Repeating one’s own words, or the words of others

·         Repetitively apologising to another person, or God

·         Gazing at certain numbers or words to cancel others out

·         Touching certain things in a special way or a particular number of times

Anxiety Care has encountered many of these responses in people who would not even admit to being particularly superstitious, let alone obsessive.

As a further difficulty, Penzel notes that, with many people, magic has to be pure. That is, a few gabbled sentences or a half-hearted attempt at cancelling in the midst of other problems, might not be perceived as of any value. If a person with this problem adheres to the belief that the undoing words or rituals have to be exact, there lies in wait a great deal of anxiety and/or depressive feelings.

‘Feedback from the external world reinforces or weakens our beliefs, but since the beliefs themselves influence how that feedback is perceived, beliefs can become very resistant to contrary information and experience.’
(Alcock)

All of us have an internal monitor concerning when we feel something is completed; with washing, for example, we all have different levels that we term ‘enough’ under different circumstances. In an obsessive washer however, this will be little to do with a rational response to a need for acceptable cleanliness.

As an example of normal differences, a charity volunteer states that when he is making a sandwich for himself, he may or may not wash his hands first, according to what he has been doing. However, he always washes his hands before preparing food for his children. His explanation is that he is happy to take his chances with contaminants in the name of laziness, but he would not force his children to do the same. In the case of his children, it would also cause him anxiety.

Another volunteer once sucked the fingers of his fourteen-month-old son when they were in a park and the boy had touched dried dog faeces. Encumbered with a pushchair and a bag, he was unable to prevent the baby from sticking his fingers in his mouth after the incident so took what to him, was the most sensible way out. (He does state that he would have given a lot for a peppermint sweet afterwards).

He has had obsessive problems, clinical and sub-clinical, and states that beyond the drive to keep his child safe, there was also a hovering feeling that he could not deal with the anxiety of waiting to see if the child had contracted an infection from the faeces. His own possible contamination was simply a ‘yes or no’ response – he either was infected or he wasn’t. No anxiety was involved, as he could do nothing about it.

As said, contamination OC’s will inevitably wash more than people without the disorder. Some will have an exact number of times that this has to be done, which might be termed ‘magical thinking’. Others will simply be tuned in to their internal anxiety levels and will cease washing when balance is achieved; and this, while invariably excessive, might be the result of a personal and solitary decision, or in response to family pressure, humiliation, exhaustion or even pain. (One client states that his washing is often curtailed when the hot water runs out and the subsequent pain of very cold water on his body becomes too much to bear).

If a person sufferers from magical thinking, the curtailing of such a ritual before perceived completion might cause much anxiety and depressive feelings. A magical thinker would probably not be able to rationalize the ‘pressures to stop’ as detailed above, as his or her balance between complete and incomplete would not be a vaguely internal response that varied according to the situation. Instead, it would be a rigid, unalterable need that had virtually nothing to do with the current environment.

‘…a view of the self that is dangerously mistaken and must be rejected: the notion that the self is some sort of “essence” within a person that is basically good or bad – and that a moral appraisal of a person’s thoughts and feelings will determine into which category his “essence” falls.’
(Branden)

As with all therapeutic responses to OCD, a magical thinker must, at some point, confront the need to take a chance: that they have to accept the possibility that harm may come to somebody if they do not ‘cast spells’. Regardless of how much this response to the OC prompt is perceived as necessary, it has to be acknowledged, sooner or later, that this version of the disorder is substantially interfering with the quality of this person’s life.

The problem is, magical thinking is very unlikely to be a conscious choice – people do not cast around for ways to deal with their OCD and pick the best one. Their response is going to have a lot to do with their nature, upbringing and culture. In this situation, the ‘mind-set’ of a person, the filtering process that determines how they perceive and process thoughts will be as natural to them as breathing, strange as it may seem to outsiders. As said elsewhere, when someone has internalised responses to life so that they become ‘truths’, as obvious and needing as little discussion as the difference between day and night, it is extraordinarily difficult to change this perception without a great deal of conscious activity and, often, faith in the person or person’s urging this change.

‘Scrupulosity is characterized by excessive worry, self-doubt, fear of taking risks, anxiety, embarrassment, intrusive thoughts, rituals, guilt, crippling indecision, problems in social and occupational functioning, and avoidance of the fullness of life.’
(Duckro & Williams)

SCRUPULOSITY

Scrupulosity, as described by Duckro & Williams in their excellent article, has its beginnings in a ‘delicate conscience: the more delicate a conscience, the more it will be agitated by an inconsequential thought and excessively disturbed by some trifling matter. And this can cause great pain’ (Kolvenbach). Pedrick sees it as mainly a religious obsession but with hyper-morality and hyper-responsibility as major factors. And Cardinal O’Connor says that it always involves fear. He further states that ‘if anyone needs an awareness of the mercy, the gentleness, the love, the forgiveness of Almighty God it is a scrupulous person.’

For our purposes, we will look at scrupulosity as separate from general obsessive thinking that links to conscience; and define it as based in religious beliefs or a strong stance in that general region of personal life where ‘sin’ and ‘evil’ have an inappropriate amount of space in which to grow. And where sufferers are overwhelmed by a need to get everything in that area precisely right to the last detail; where they are extremely conscientious, hesitant, doubtful or uneasy and obsessive about deciding what is right or wrong.

According to Duckro & Williams, there are no reliable statistics on the incidence of this disorder, but they quote Ciarrocchi where studies show that (presumably in America) 25% of Catholic High school students and 14% of Catholic college students reported scrupulous behaviour. While the USA tends, as a general rule, to have a stronger and more fundamental approach to religion than the UK, their statistics in other areas of anxiety disorder and OCD do not vary much from the European, so it is reader’s choice as to what to make of these figures.

Van Orum’s book, “A Thousand Frightening Fantasies” as discussed by Cardinal