Wednesday, June 23, 2010

Inconsolable: OCD Melt Downs

I watched episode 4 of VH1's OCD Project. The person I identified most with in this episode was Kristen. I don't have contamination OCD, but I've been in that paralysis of avoiding doing a task because I will do it wrong and ruin everything. For Kristen, putting away her laundry was a monumental battle that doesn't play as dramatically on tv as eating off a toilet. It took a lot of courage on her part to risk contaminating everything she had just washed, and then be deluged with the anxiety of wanting to clean it all over again. I love her brother Theo. He is her link to the former "free spirit" she said she used to be. He knows she's still in there somewhere.

The phone call between an inconsolable Kristen and Theo, as he gently told her he wasn't going to come get her, was very powerful. He reminded her that what she wanted was to get better, which means putting aside the desperate desire to flee the anxiety. My therapist just recently talked about the parallels between the intense anxiety of obsessions, and a child who is inconsolable. The fear is very "young," and comes from a different place than our adult selves. I recognized the intonation in Kristen's voice. I've done this with my therapist, where he has to guide me from point to point when I was frozen in fear.

But I am troubled by the dynamic between David Tolin and Kristen and his tendency to revert to "black and white, all or nothing" thinking when he interacts with her, with a dose of power struggle thrown in--his insistence on a 5 minute shower as an end to itself, his "either fight the OCD or don't," and the snarky comment about Kristen needing to drop the Princess Act. The therapeutic alliance is really important in Exposure Therapy for a lot of people. The first thing Leonard said to me when we met was, "You have to tell me if you don't like me, because rapport is essential."

Does David Tolin really believe that Kristen is just spoiled and stubborn? He said he wouldn't negotiate with her, that she needed to either do the Exposures or not. For some people, this might work as a strategy, but in my opinion it sucks. ERP has a high drop out rate, which is disturbing, because ERP is a treatment that works for OCD. I believe there is a temptation on the part of some therapists to label someone "non-compliant" if they don't do their exposures, instead of figuring out why they aren't willing to do them, and working to give those reasons less credibility. Even 20 years ago, people with OCD were considered hopeless by much of the therapeutic community. I'm sure it is exhausting being an Exposure therapist at times. It's exhausting living with OCD.

OCD will always want to bargain and argue, but people with OCD are more than just the OCD. The healthy part of Kristen signed up for a hellacious show because she wants to get better. That is who Theo addressed when he talked to his sister on the phone, and he acknowledged the fearful part of her with considerable compassion. When we feel OCD anxiety, it is using our one and only nervous system. It feels real. OCD has no respect for me as a person--it is all about reducing anxiety, even at the expense of having a life. It feels death defying to put away clean laundry if you believe it's contaminated. It isn't pretend. Facing that fear by doing Exposures takes courage, and in spite of the perception of Kristen as a Princess, she is showing a lot of courage.


  1. Yeah, I watched/listened to episode 4 and my sympathy is with Kristen. Why couldn't Tolin help her go from 8 to 7 to 6 to 5 minute showers? That's more how I've "succeeded" with ERP (except that I wouldn't improve quite so consistently). And having the shower shut itself off would bother me - I want the control of that. Or Kristen's feeling sick. For me, the sick feeling is a general build up, not tied in specific time with the actual exposure. It's all fine and great to feel sick for an hour when I want to work on OCD, but make that look more like 24/7 and I'm sick of it.

  2. " It feels death defying to put away clean laundry if you believe it's contaminated. It isn't pretend. Facing that fear by doing Exposures takes courage, "
    Amen Amen Amen! :)
    It's nice to hear your reviews about this show. I can't bring myself to watch it because it hits a little too close to home.

  3. I completely agree with you! I also found the way Dr. Tolin handled Kristen's struggles particularly disconcerting. While I recognize that sometimes a bit of a push is needed, from what they have shown, that approach doesn't seem to have been too helpful for her. I was really surprised when, at the end of the episode, Dr. Tolin said something along the lines of "thank goodness for Theo." I was just thinking, "wait, this is the kind of conversation HE should be having with her."

    I can certainly relate to Kristen's struggles with laundry, as I have had to do (and still do when I muster the courage) very similar exposures, mixing "dirty" clothing with "clean" clothing and having to live with the fear that I will eventually either have to accept my wardrobe in it's "contaminated" state or go through some sort of hellish cleaning ritual that involves washing every piece of clothing that I own.

    I don't know what I would do if I were in Kristen's position. As I often already doubt myself and whether I am trying "hard enough" when doing exposures, Dr. Tolin's all-or-nothing speeches would only make me feel like I really was lazy, stubborn, not being willing enough, etc. I've noticed that giving myself internal lectures like those Dr. Tolin has given Kristen usually only serve to increase my anxiety and desire to ritualize. It's when I am on my own side, fighting against the OCD, that I am most successful. Tearing myself down or having someone else tear down my success or lack thereof really doesn't help. I feel like everyone is different and if one strategy doesn't seem to be working for one person, it should be the therapist's job to take into account that particular client's needs and tailor the exposures accordingly rather than rigidly following a predetermined plan.

  4. I find your descriptions yourself and others living with OCD mesmerizing. So honest - something I admire and struggle with myself. You're really opening my eyes to my own "bordeeline OCD" (per doctor years ago) and I appreciate it more than you could know. Is this show currently on?

    Best always,

  5. Queen of OptimismJune 23, 2010 at 7:05 PM

    Sorry - found your initial post with link. Not sure I am ready to face this myself......

  6. Theo is awesome. If only we could all have a Theo in our lives :) And I'll tell you, Kristen did better with that laundry than I would have, I was so proud of her and absolutely inspired. I didn't care for Tolin's snarky comment about her "Princess Act" either, because she doesn't strike me that way. She is just scared half to death.

    I absolutely love this quote: " The fear is very "young," and comes from a different place than our adult selves."

  7. Thank you so much for this post. Too many people are applauding Tolin for his show and his methods. I think there needs to be more feedback that Dr. Tolin needs to hear. I would encourage you to go to his facebook page and tell him. He needs to understand that not everyone is just being a spoiled brat when they don't want to do treatments--its up to him to find a better way to deal with these people as he supposed to be the doctor.

  8. From what I've seen of the show, I think Tolin is a total jerk and can think of stronger names to call him too. Where the heck is the compassion? How dare he call her a princess for being scared. Tolin is a disgusting human being and a filthy pig. Just my humble opinion though.

  9. Anonymous--I appreciate your desire to present David Tolin with more feedback about his labeling of Kristen. I will give this serious consideration.

    ocdbloggergirl--welcome! You summed it up perfectly, "how dare he call her a princess for being scared."

  10. I wrote this on Tolin's wall and didn't want to hurt his feelings even though I commented on your blog that he was a pig, but I was mad thinking about Kristen at the time.Anyway:

    I don't mean this in an unkind way, but making people eat off toilets was cruel. I could see someone touching a toilet , then not washing for awhile, such as that. It seemed to be exploiting people like they were in a neurotic sideshow. As an OCD sufferer, I respectfully submit that to you. I don't mean to say you don't care about your patients -I'm sure you truly do