By Dr. Fred Penzel
Over the years, I have watched my OCD patients putting great amounts of emotional, mental, and physical energy into the struggle against their symptoms. OCD, as we know, is especially characterized by doubt, and they seemed to believe that there just had to be a way to overcome their crushing doubts and the severe resulting anxiety. They usually did this by trying to achieve perfect certainty in one way or another. They had to get their compulsions ‘just right’ to make sure that something bad had not already happened, wasn’t happening now, or wouldn’t happen in the future. Unfortunately, they had all overlooked the major flaw underlying these attempts, which was that there is no such thing in life as perfect certainty. It is quite understandable why someone with OCD would do this. You might say it is instinctive to try to be perfectly certain in an uncertain and potentially threatening situation.
Given the fact that we do not live in a perfect world, that human beings are all basically flawed and imperfect, that we cannot predict the future, and that we cannot control very much outside ourselves, it is easy to see why the quest for certainty will always be doomed and hopeless. Clearly, anyone starting out with a doomed project is going to waste a lot of time and effort, and that only anger, anxiety, and depression can result. This is one future happening we really can predict.
So, with this in mind, what’s an OC sufferer to do, if relief from anxiety and doubt is their goal? We already know what doesn’t work, so that eliminates a lot of possibilities, including compulsive checking, counting, avoiding, repeating, reassurance seeking, washing, questioning, analyzing, undoing, saving, performing magical rituals, etc.. I like to remind my patients that these tactics never worked in the past, aren’t working in the present, and are unlikely to ever work in the future. We can file them all under ‘Hopeless.’ Granted, it isn’t always easy to convince sufferers that their tactics really are hopeless. Some folks have to sink to the bottom and suffer major losses in their lives before they are finally willing to admit that their compulsive attempts to relieve their anxiety really are hopeless.
Logic would seem to indicate that when you are clearly fighting for a lost cause, have been defeated at every turn, and have no chance of ever retreating, regrouping, and turning things around, your only other option is to ‘give up.’ Basically, this involves symbolically raising your hands, raising the white flag, and saying, “I surrender.” Understand, too, that this surrender must be unconditional and total. You cannot surrender some of your symptoms and still keep others.
So is that it? The answer is, “Not exactly.”
In the world of OCD, one of the big truths you come to discover is that it is a realm of opposites. OCD turns out to be something known as a paradox. One definition of a paradox is – “A statement contradictory to received opinion.” In this case, it would be the statement that, “All the things you thought were going to make you better, will only make you worse.” That is, the compulsions you thought were going to make the thoughts and the anxiety go away only ended up taking over your life by making you addicted to them, and ultimately, paralyzing you. Put another way, your attempts to use compulsions (no matter what kind) start out as solutions to the problem of obsessions, but they gradually become the problem itself. In this world of opposites, however, it also turns out that, “The things you thought were going to make you worse, happen to be the very things that make you better.” How does this get turned into something that you can use to help yourself?
In line with this being paradoxical, it means that you need to stop escaping and avoiding, and face the very thing you fear. Obsessive thoughts are internal mental events that run on their own biology, independent of your other thought processes, and therefore can’t simply be shut off. They are not something in your external environment that can be run away from. The truth is, there is no escape from what you fear, and therefore the only real option you have is to face it. If you look carefully at any good treatment for fears, phobias, and anxieties, they are all ultimately based on facing what you fear. Facing what you fear is a way of getting closer to the truth. You are no longer speculating about what might happen – you are finding out what really happens. Everyone with OCD has a theory about what will happen if they do or don’t do their chosen compulsions. I like to tell my patients that facing your fear is like being a scientist testing your theories to arrive at the truth. In the case of OCD, the truth people discover is that their theory is disproved, and the dreaded consequence never happens. Just telling them this, however, is not enough. People have to experience this for themselves for it to have a real impact.
In practical terms, what this means is learning to gradually surrender your compulsions and it means learning to agree with all your intrusive unpleasant doubts. I make it a point of informing patients that the anxiety isn’t the real problem. The compulsions are the problem, and are what tie their lives up in knots. Many of you will remark at this point, “Easy for you to say. The thoughts seem so real that I can’t refuse to act on them. How can I stop doing compulsions? If could do that, I wouldn’t have OCD.” The thought of opposing your thoughts isn’t always easy to grasp. This is because we humans tend to walk around with the idea that because we think something, it must mean something, must be important because we thought it, and must be acted on. In the case of OCD, however, this doesn’t turn out to be true. An engineer and former patient of mine found it helpful to label his frightening obsessions as synthetic thoughts. I think this is a good way to characterize them. Even if you can’t label them in a helpful way, you can at least try to take it on faith that what the thoughts are telling you may not be accurate.
In addition to the thoughts seeming so real, many sufferers seem to have the idea that, “OCD makes me do these things.” My answer to this is to say – No, OCD can only whisper in your ear and tell you dislikable things. It cannot make you do anything. While it is true that obsessions are biologically generated intrusive thoughts, compulsions are simply very bad solutions you, yourself, have invented as a way of dealing with the anxiety resulting from your obsessive thoughts. You make yourself do compulsions. You have created them, and all the rules governing them. You rehearse them and turn them into habits. The bulk of the problems occurring within your OCD come from you. The main reason that compulsions seem so hard to stop is because you have rehearsed them so often that they have become very automatic habits that are easy to do without thinking. You get good at things you rehearse a lot.
This is where we get to the good news. I say this, because if you are creating, carrying out, and practicing these things, then you should also be able to stop them. You made the all rules, it is your game, and you can therefore change the rules. Is this easy to do? The obvious answer is, “No.” Tackling them is hard work. No question about it. I would never say that overcoming OCD is easy, and I never use that word when it comes to OCD. Most of the important things in life never are.
So how do you go about getting yourself out of this paradoxical OCD fix? In order to do this, you need to first accept several things:
1. there really is no escape from what you fear
2. the compulsions don’t work, will never get you to a place where you can live life as you really desire, and must be surrendered
3. the responsibility for your compulsions is yours, and yours alone, and that you are making yourself do them – not OCD
4. you are really the only one who can eliminate them (although you may need guidance in doing this)
5. they must be faced one way or another if you are to recover, and that it will not be easy to do
6. you will have to eliminate all of them if you are to stay recovered
Once you have accomplished the above, the next step is to get yourself into treatment, whether it is of the self-help variety, or done with the help of an expert therapist. This treatment should take the form of what is known as Exposure and Response Prevention (E&RP). In a nutshell, it involves gradually exposing yourself to, and agreeing with, increasingly fearful and challenging obsessive thoughts and situations that will cause the thoughts, while at the same time resisting the urge to do the compulsions you have used to relieve your anxiety. Going back to our title, you have to gradually surrender to having to face your fear, and surrender your compulsions. In doing this, you will gradually build a tolerance to the things you fear, and also weaken the connections you have created between having your doubtful, fearful thoughts, and performing compulsions. You will find that your anxiety decreases as your tolerance increases, and that the thoughts have less and less impact. Eventually you can accept that you can have an obsessive thought and not have to act on it in any way. A good therapist can set up and help you with a treatment plan designed to accomplish all this. Medication, too, can help this process by lessening the intensity and frequency of the thoughts.
How long will this take? That depends upon how many thoughts and compulsions you have to work on, whether you get help from medication, and how willing you are to take on your symptoms. Don’t wait around. If you procrastinate about it, it certainly won’t happen any sooner. Start working on your surrender.
Fred Penzel, Ph.D., is a licensed psychologist who has specialized in the treatment of OCD and related disorders since 1982. He is the executive director of Western Suffolk Psychological Services in Huntington, Long Island, New York, a private treatment group specializing in OCD and related disorders. He has written numerous articles that have been featured in many issues of the OCD Newsletter.