In exploring the history of Exposure Therapy for OCD, I came across Aubrey Lewis, clinical director of the Maudsley Hospital in Britain. Many of subsequent developers of ERP were recruited or encouraged in their work by Lewis. In 1937 he wrote an article on the Problems of Obsessional Illness, where he describes some of the characteristics of obsessions. One definition he liked was by someone named Schneider:
. . .contents of consciousness which, when they occur, are accompanied by the experience of subjective compulsion, and which cannot be gotten rid of, though on quiet reflection they are recognized as senseless.But Lewis notes that the recognition of the obsession as senseless is not essential, but the aspect of feeling one must resist the obsession is key--attempting to ward off painful and overwhelming obsessions, and paradoxically, ". . .the more overwhelming and painful the obsession, the more urgent and unsuccessful the devices to ward it off."
I recognize my experience in this! I also see the paradox that when I am at my most panicky, it is unlikely I'll get to the point of "quiet reflection", and even in 1937, Lewis recognized the limits of Cognitive Therapy with OCD, stating that, "Critical appraisal of the obsession, and recognition that it is absurd represents a defensive intellectual effort, intended to destroy it: it is not always present, nor is the obsessional idea necessarily absurd."
This is where Grayson's book Freedom From OCD really helped me in recognizing that some things I obsess about could actually happen, but that trying to get absolute certainty that they won't is impossible, and that I actually tolerate a lot of risk in the areas not affected by my obsessions, like when I worked in a hospital, and didn't worry about contamination.
Lewis describes the sense of having a part of one's self or mind working independently, not as an integrated part of oneself, and the desire to fight against it. Also, the acute awareness of "internal speech" and having words said outloud come back into one's head. Finally, he mentions depersonalization, where the patient,
. . .is commonly so far from feeling the master of his own thoughts that he has almost no personal or free share in them at all. . .Lewis believes that depersonalization is a state that affects all thinking, not just parts of it, as in obsessions, but that they are similar. When I start web searching, I feel some of this exclusion from my own self. There are things I actually want to do with my life, and yet these recede in the face of an obsessional thought about needing to do things "perfectly" and subsequent compulsive trance-like searching of the internet. Lewis does not discuss treatment, and rambles a bit, but I appreciate his attention to what the experience of obsessing and compulsing is like.
What do you notice about your obsessional thoughts?