Thursday, July 29, 2010

Scrupulosity and the Body: Lunch with the Religious

Yesterday I walked into the middle of an exposure so surreal I thought maybe my therapist orchestrated it. I was meeting a friend for lunch at a restaurant that is part of a conference center. The parking lot was packed, and as I was circling around looking for a space, I started to notice the large number of bumper stickers about respecting life, marriage and chastity(the one I am still pondering is "Chastity is for lovers.") I walked into the lobby, and my friend was sitting there in a sea of nuns in full habit and priests in clerical collars, with some lay people mixed in.

There was a long line of various religious folk at the hostess desk, but fortunately I had a reservation. We were seated next to a man in a floor length black robe and a gold cross about 8 inches long, and people kept coming up to him to reverently say hello.

I went through several years of struggling with scrupulosity centered around Catholic theology, for instance, contraception being a sin. Of course the irony is that I am not Catholic. My first boyfriend was Catholic, and later I worked at a Catholic college, and being introduced some of the central Catholic issues set off a cascade of anxiety. This is the bizarre thing about having OCD--I can latch onto a thought, and wrestle with it hoping to make it go away because it disturbs me, but which has no connection to my actual beliefs. The thoughts that I feared were "What if contraception is wrong? What if I am going to hell? What if I am supposed to be Catholic?" And this is what makes dealing with scrupulosity incredibly hard--there will be people who do believe I should convert to Catholicism, who wouldn't interpret my anxiety as OCD, and this compounds the anxiety.

So there I was yesterday, enveloped in a conference about Catholic theology of the body, and I did ok. I was uncomfortable, but I focused on my friend, who is going through a hard time right now. I didn't go home and look up the conference, or research the agenda, or the supposed immorality of contraception, or sites that say a marriage without children is a sin, or read conservative Catholic websites like I used to do. At the worst of my scrupulousness, I was subscribing to a mailing list about natural family planning, trying to figure out if there was any way I was redeemable.

Yesterday I was even able to laugh at the over-the-top exposure material. Today I am feeling tired and unsteady, but I know for me the act of faith is choosing what I believe. Yes, that is exactly what will rile some people up--and I am learning to live with that.

Although I am not Catholic, ironically I did find Scrupulous Anonymous to have some helpful articles:
Scrupulous Anonymous: Newsletter by Liguori Publications

The Scrupe Blog is moderated by a Lutheran Minister and often has quotes from religious folk who suffered from tormenting thoughts:
The Scrupe Blog

The first book I read on scrupulosity was psychologist's William Van Ornum's A Thousand Frightening Fantasies: Understanding and Healing Scrupulosity. The author did a survey of sufferers, and I realized I wasn't alone.

I heard Ian Osborn speak at one of the IOCDF Conference's and his talk about scrupulosity was very interesting.

Tuesday, July 27, 2010

Just One More Search: OCD and Information Overload

information overload
There's a discussion that threads through the OCD-Support group on Yahoo about providing information and changing beliefs as a way to treat OCD rather than doing exposures. When someone asks about a particular feared consequence in the OCD-Support group, there is almost always several people writing to reassure the person that what they fear won't happen, and sometimes a defensiveness about the basic human need for accurate information and compassion. What unfolds in many cases is that the person already knows the information(ie. how HIV is contracted), has had repeated tests, and asked the same questions many times.

A compulsion is usually the tip of the iceberg, with a lot of suffering underneath, and there are always people who will say, "That's not a compulsion, that's a good idea." At age 27, I once told a doctor I was anxious about skin cancer, and she said "Good, you should be." She didn't know that I was checking my moles constantly, researching skin cancer, and that none of this actually made me any better and identifying moles that might be abnormal. It's not compassion to encourage life eroding rituals.

In my experience, I could never get enough information. I've earned my living doing research, and I'm good at it. I read 12 books on OCD the first month I started treatment with Leonard, but it wasn't helping me since I was trying assuage the part of me that was afraid I didn't have the perfect treatment, and that I wouldn't get better.

Fortunately, I was able to be honest with my therapist about all the reading I was doing. He didn't fit the authoritarian stereotype of an Exposure Therapist, and he did give me some information, but it was information about the nature of the disorder, about the constant desire to have 100% certainty, and that his clients get better, but he couldn't give me an absolute guarantee, and asked me to consider taking the risk and doing the treatment, and not reading more books. He wasn't asking me to follow him unquestioned, or demanding I do what he wanted. He was appealing to the healthy observant part of myself that wanted to get better. We all have this part, no matter how buried under OCD.

Thursday, July 22, 2010

A Perfect Schedule Does Not Exist

Yesterday in session with Leonard, I admitted my anxiety was up about doing a schedule, and I hadn't done one that week, so he suggested we do one right there in his office. Meh. I was up against the usual suspects--fear of choosing the wrong activity, at the wrong time, in the wrong quantity, and that failure to do everything would mean I was a defective human being. That's a lot to carry into schedule making!

Leonard argued that the *perfect right way to be* is only theoretical--it's not reality. There are things I really want to get done, and they are different things than what the OCD wants. I spent last week floundering around on the computer, getting stuck in one task and feeling like I must finish it, and then suddenly the day was over. So I got my notebook out in my therapist's office, and felt a surge of anticipatory anxiety, tightness in my chest and heat in my face. Actually picking things to do was not as bad as anticipating it(and the perfectionistic voice was squawking, "Why didn't you do the schedule sooner, since obviously if you'd just started it, you would be ok?" which is direct opposition to the previous squawking about "If you start a schedule, and do it wrong, you are doomed."

My OCD mind has a very limited understanding of time, or of how things get done, or how to be pragmatic. I imagine a perfect reality that I could obtain if I just tried harder, but in fact my life is happening right here, right now. Leonard suggested this is the true perfection--staying in the moment long enough to actually do what I value doing, and that aiming for perfection is a "young" strategy, a child's way of fixing pain, "Make it go away forever by doing everything just right." I remember being almost heart broken in my 20's when I would get a task done, and then there was another one to do, and it was such a disappointment to find I wasn't completely done.

To make things even more complicated, Leonard said I might discover my schedule needs to change based on what is happening at the time! He advocated for compassion with myself--that whatever I get done is more than I would've when completely entangled with OCD, and that the OC perfection voice will be loud, and I can just let it be, and go on with my day. The existential voice of doom wants to fix all of this, research the best tasks to do, or best organizers or read more books on OCD, but this is a danger signal--repairs, fix-its, or "figuring out" often lead to more OCD. Sometimes it feels like working without a net--up on the high wire, choosing things with wild abandon, but I do know my usual way of approaching my day leads to being trapped underground with no light to see my life.

Friday, July 16, 2010

Busy Work and Incompleteness OCD

The stack
Thinking about my time, it occurred to me that I do a lot of "busy work" in relation to my OCD. In fact, my compulsions are busy work incarnate. I remember being in school, and teachers giving out worksheets to keep us quiet, that didn't actually lead to learning anything, and compulsions are similar way to keep the OCD quiet, except of course it manages to come back squawking! Yesterday, I was in a store with a whole aisle of picture frames, and I felt a wave of anxiety that I needed to make sure I didn't miss one that was the right size, so I'm glued to the shelves, picking frames up and putting them down, and the frame I eventually bought doesn't fit anyway, not to mention that there was no real urgency to get a frame, except in my own OCD mind.

I came home and did some of the things I really needed to do. My husband was going to do a craft show by himself this weekend, but since I'm not going to the IOCDF Conference, I am going with him, and needed to pack up for that. I was wiped out by the time he got home from work because I crammed all the necessary tasks into 1.5 hrs, and my back ached. But I am still grateful that I have this much awareness of what is going on. 15 years ago, I volunteered to do the mailing list for a group I belonged to, and I sat at the computer trying to figure out how to merge mailing labels, and entering addresses, until my shoulder was throbbing, and completely baffled with myself. I could see that it made no sense to keep sitting there typing in names, but I had an overpowering urge to finish, and no understanding as to why.

I'd noticed this need to complete things, to hit every chapter in a book, including the pages with roman numerals(my husband tends to skip introductions, which was very alien to me), footnotes, appendices, indexes. A sense of dread would envelop me if I skipped a page, or didn't understand a particular sentence before moving on. My love of reading was more powerful, in part because reading itself was a compulsion, and also a distraction from whatever was going on in my life, that I would manage to consume large quantities of books in spite of being slowed down by the nagging anxiety that I wasn't thorough and complete.

This is part of why I procrastinate--the fear that once I start something I will feel compelled finish it, no matter how useless an activity it turns out to be, or whether it causes me bodily pain. What kind of busy work is your OCD handing out?

Wednesday, July 7, 2010

A Wave of Sadness

I found out yesterday when I went to work that it was my last day. I am being laid off and my department closed. I am still dazed. The other layoffs happened while I was on vacation. I packed up my things, which took awhile since I've been there for 12 years. My supervisor was very compassionate, and I could tell he didn't want this to happen to me.

I am feeling very sad that I didn't get to say goodbye to the people at work. It's a hard thing to comprehend. I had projects in process, and now they are abandoned. I also have a lot of apprehension about losing health insurance, income, and having too much time to focus on my body and my OCD thoughts. It helped to see my therapist today.

I cried when my husband told me that we needed to make sure we found a way for me to keep seeing my therapist, because he knows that will help me deal with the loss, and that he wants me to enjoy my life, that this is important to him. I am very grateful he is in my life.

I regretfully canceled my trip to the IOCDF Conference in order to conserve funds. I am disappointed I will not get to meet some of the wonderful readers of this blog! I hope that at some point in the future, our paths will cross.

Sunday, July 4, 2010

Built on Sinking Sand: The House of OCD and Health Anxiety

Sunk and askew

It was the summer of 2006 when I sank deeply into the OCD with a full scale health anxiety crisis. OCD thinking is like an elaborate structure built on sinking sand. It appears so real and solid and indisputable and all the while your life is collapsing underneath you, and the logic is built on inherently unstable ground. OCD is an entire industry of thinking with very little to do with the outside world, except for the grain of truth that it inevitably latches onto.

Even writing about this summer stirs up the OCD. Part of my compulsion to make the anxiety go away was to make detailed notes about my symptoms, in hopes that I accounted for every possible thing, so my impulse, when writing this blog post, is to include every detail. The anxiety began when I agreed to take a medication which might alleviate a symptom that I obsessed about frequently. I took the medication, and started obsessing that I was getting a bladder infection, which was another one of my health anxiety themes. After fixating on every bladder sensation, and agonizing about whether to call my doctor, I finally did and she got me in at the end of the day. It is common(though perhaps not recommended) to treat women empirically if they have bladder infection symptoms, so that's what she did--no urine test.

And that began an elaborate building of health fear, one level on top of another. Because I'd had a severe headache with one antibiotic in the past, I said I wanted a different one, and in dodging one fear I landed in another as I began to obsess about getting a yeast infection from the 2nd antibiotic, and called my doctor who prescribed meds over the phone. I was overwhelmed with a surge of anger at my doctor for not doing a urine test since I had several bladder infections that turned out not to be, and since strong feelings set off my OCD, I was on very shaky ground.

Over the next weeks the OCD was compounded and grew at an alarming rate. I went to a different gynecologist, who was near my house, who did a lab test and said I did not have a bladder infection, and gave me more meds for the supposed yeast infection. I still felt urgency in my bladder, and even more urgency in my OCD desire to know exactly what was going on in my body, and perfectionistic self-condemnation for not perfectly diagnosing myself or advocating for tests, or for calling a doctor in the first place. The OCD thoughts were all about my defectiveness, and my responsibility to make sure I didn't get a kidney infection, and the imperative that I never make a mistake, and that I would be haunted by the pain and discomfort in my body.

I was on a quest to get relief from my anxious imaginings and my fixation on painful sensations in my body. I found a new family doctor, who said if I still had bladder urgency that I probably did have an infection, and she wrote a script for antibiotics, and reluctantly did a urine test at my request, but when I panicked that I did not do the test sample correctly, she went into authoritarian mode and told me to not get myself worked up, to just calm down. Well, if I could do that, I think I would have already. . .I went and cried in my car.

So here I was trying to decide whether to take another antibiotic, without test results, and the OCD structure was growing, as I felt a surge of hyperresponsibility that if I got a kidney infection it would be all my fault, so I'd better take the antibiotic. By the end of that week, I couldn't sleep at night, and I went into the doctor on a Saturday. The doctor on call was much calmer and kinder, and she prescribed another antibiotic that would be less likely to cause insomnia, but this antibiotic wreaked havoc with my digestive system. I went back to the doctor on call who happened to have my test results, and once again it showed I didn't have a bladder infection but that I did have blood in my urine, and she wanted me to see a urologist.

By this time I was a mess. My therapist Molly was on vacation. I went to see the therapist on call, and told her how I couldn't get this right, couldn't figure out what was wrong with my body, that I needed to try harder. She sat quietly for a moment, and then said that it seemed I had been working incredibly hard to find out what was wrong, with multiple doctor visits and relentless researching on the computer. I was baffled by this. This did not make sense in my OCD world, where I was never good enough, never finished, never solved, never certain.

She wrote a few sentences on a scrap of paper, and gave it to me:

May I be filled with lovingkindness.

May I be safe from inner and outer dangers.

May I be well in body and mind.

May I be at ease and happy.

This was a glimmer from outside the windows of the house of OCD, the possibility of another way to view the world. Feeling body symptoms can be hard enough without the "inner dangers" of OCD. I was to descend further into my OCD, but I had a moment of reprieve.

Thinking about it now, this is part 7.5 of my Medication Series, since it was my first OCD crisis after ceasing to take my antidepressant.

Part 1: OCD and Medication Decisions
Part 2: Starting Medication while Struggling
Part 3: The Limits of Research in Medication Decisions
Part 4: My First Prescription for SSRI's
Part 5: Feeling it in the Jaw: Side Effects of Medication
Part 6: Being on Medication & OCD Weeping
Part 7: Wanting to Get off my Medication

Friday, July 2, 2010

Home from Vacation

I'm back from my vacation to Washington DC, and I had a good time! My husband and I walked thousands of steps, and saw 14 museums. I was very grateful that I started OCD treatment before going to DC, because the sheer quantity of things to see would've been overwhelming, since part of my compulsions was making sure I didn't miss anything. My husband has trouble sitting still, and likes to roam around museums. A few years ago we realized that we have the best time if he just starts roaming, and leaves me to read all the interpretative signage, and now it's even more improved because I have much more ability to move on even if I haven't finished every single word, and looked at every single item on display!

My desparate OCD compulsion to not miss anything would've been paralyzing in DC. I still had some difficulty at times. At the Museum of the American Indian, the cafeteria was full of interesting dishes I'd never had, and suddenly a several tour groups showed up and the lines got very long. I had a "nested basket" response of "Oh no, you took too long to decide and now there are crowds. How could you do that? What is wrong with you? Oh, I shouldn't be so critical of myself. Why can't I stop doing that?" but I focused on choosing some dishes easiest to get to, in spite of a barrage of "You need to choose the right one, how do you know it's the right one?" and did enjoy most of what I got. The cold radish and melon soup was delicious, and worth the risk. The maple pinto beans were not as exciting, but I am so much better prepared to just say, "Oh, well," and let the disappointment pass.

The photo above is of Christian Burchard's Basket Series from the Renwick Museum of Contemporary Craft. I asked my husband to take a photo of it, because it is such a powerful metaphor for my OCD thinking.

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