Not long ago I was browsing a quaint rural giftshop, the type where every product has been carefully positioned such that you want everything despite needing nothing.
I caught the eye of the shop assistant curating the window display. Eager for conversation, she tells me about her merchandising and proceeds to mention that she is “a bit OCD”. I notice that she wears the words almost like a badge of honour. “I love everything in its place,” she explains, and paints me a picture of her own manicured livingroom full of carefully chosen useless items. She appears almost proud of her perceived obsessional tendencies which are commendable in today’s busy and cluttered world.
My friend James (not his real name), who has OCD, or obsessive-compulsive disorder, generously agreed to be interviewed about his own experiences. James fully bought into my awareness the manner in which people declare themselves to be “a bit OCD”. He also highlighted the trivialising of OCD in advertising slogans chalked onto trendy sandwich boards reading “obsessive caffeine disorder”; a seemingly lighthearted attempt to seduce potential coffee-purchasing passersby.
As a clinical psychologist I have worked with many people diagnosed with OCD, as well as those I know from my personal life. When I began to examine the language of OCD I found myself thinking about a range of mental illnesses and diagnoses; how they seem to fall into a strange hierarchy with variable public perceptions and differing levels of stigma allocated to each. It strikes me there seems to be no stigma attached to being “a bit OCD”, but that the reality of living with OCD and speaking openly about it is quite different.
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James tells me that his OCD started when he was seven years old and his friend’s mother died from cancer. He became afraid of getting sick and attempted to keep himself safe by engaging in various compulsions such as counting sips of drinks consumed, touching door handles, and frequently checking doors were locked.
I ask him what it is like to look back at his younger self. “I feel quite sad for myself, nobody knew what I was going through . . . I did try a few times to explain what was happening to me but I was just told to deal with it.”
James explains how OCD stopped him having a normal childhood. “I was always exhausted by how much time I would waste, I could rewrite a sentence five times because each ‘e’ had to be perfect.”
OCD is an illness which can be almost invisible to the outside world, and can be diagnosed in individuals who may appear to be otherwise functioning very well, even excelling in their lives. Yet behind closed doors and in the depths of their thought processes, they may be stuck in an infinite number of obsessive thought loops, cycling round and round.
These obsessional thoughts come in many forms, such as fears of contamination and harm, or may relate to more taboo themes such as incest, violence or sexual aggression. The obsessional thoughts can only be calmed or neutralised by compulsive mental or physical behaviours (e.g. checking, ordering, washing), rigid avoidance, or reassurance-seeking such as asking repeatedly if you have done wrong in a futile effort to assuage the unassuageable doubt. Unfortunately, these repeated acts used to quell or block the thoughts tend to provide only brief relief, and ultimately reinforce the entire process.
It wasn’t until he was 22 that James realised he had OCD. I wonder about those 14 years of confusion in between, and the added pain of not understanding what was happening. For James this label of OCD was relieving. “I was reassured to know that this was normal, and that I was not alone.”
James is remarkable in his resilience and self-awareness, and tells me that today his OCD is much more manageable. He reached a point where he had had enough and began to expose himself incrementally to each of his fears, learning to tolerate the resulting anxiety until the fears became less, some even extinguished. This is similar to a standard treatment approach for OCD known as exposure and response prevention used by many therapists. He also tells me he continues to do therapy but no longer finds the exposure approach is helpful for him, as he is now working on many of the deeper underlying issues.
James is also keen to talk about his experience of intrusive thoughts which included a fear of becoming a paedophile. He described his obsessional fear about having sex with a child, reminding me that, “there is no fun in this”.
I think of other intrusive thoughts clients have told me over the years such as, “I might murder my father” or “what if I have sex with my pet”. The distinct feature of such thoughts is they are repetitive and cause distress – because these are things the person would never want to do. They represent a fear of action, not an intention to act.
Imagine having such a deep mistrust of yourself that you could not be sure you wouldn’t do the very thing that is abhorrent to you?
Without understanding this difference, people may judge or even wish to report such a person. When I ask James about this, he responds wryly: “It’s not because I have the thought that I am the president that I am.”
Thankfully, we cannot be locked up for our impure thoughts; we have all had them but normally we can dismiss them. However, in OCD they stick and grow. “The more you try to get rid of them, the more powerful they get.” James explains that in the past he avoided children to stop the paedophilic thoughts, and with a softer tone and saddened eyes, he tells me he is not sure if he can have children because of this, and the gravity of this illness is palpable.
My conversation with James reminds me that while some people find labels unhelpful, they can be freeing for others. We have a responsibility to use them respectfully and to know what it means when we flippantly use any label. These days we are constantly debating what we can and cannot joke about, and people may feel stifled by the correctness that seems imposed on them.
I don’t wish to impose, or to cause shame for making mistakes, only for us to pause long enough so that we understand the impact of the words we say, and then we can decide if we still want to say them.