Friday, October 8, 2010

Aubrey Lewis on the Nature of Obsessions: Depersonalization and Warding Off

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?


  1. I am finding it very hard to not compulse on certain things right now. I am now learning how to identify these times but some still seem so overwhelming I have too.

    I know it takes time to learn and am not gonna beat myself up about it.

    I just got Grayson's book the other day and am working my way thru it. I am really liking it so far.

  2. I'm so glad you are reading Grayson's book--he was the first person I found who described "obsessing about obsessing" and I knew he must understand the OCD mind, because that's a big part of my experience.

    Learning how to identify when I was obsessing was very important! I used to think "Oh, no. I'm noticing I'm obsessing and compulsing. That means I'm a failure." It took awhile to realize that noticing was the first step to actually changing anything--if I avoid noticing, how will I address it? I agree it takes time to learn, and I'm glad you are being kind to yourself in this process.

  3. Oh my, yes. This quote really hit home: ". . .the more overwhelming and painful the obsession, the more urgent and unsuccessful the devices to ward it off."

    As soon as that ball gets rolling (and I have to let it happen - I can also stop it, though it is akin to stopping a moving train), it seems that more compulsions just lead to more compulsions until I am a shaking, sobbing, freaked out heap of defeat. Being in that situation soooo many times has caused me to realize that maybe a little bit of uncertainty isn't the worst thing in the world. I do still crave it, I won't deny that. I think I always will. But I am starting to understand that even with the most time-consuming rituals, there is still a small chance that I will not prevent the imagined catastrophe and then I have wasted a huge chunk of my day/week/life for nothing.

    Great post!

  4. Never heard of him. Just stumbled on your blog today but very interesting. I know I have ocd tendencies but probably would not be classified as such. I know most people in the world have some kind of obsession or distorted thinking. I know when I get stressed I clean more and when I am more relaxed it doesnt seem to bother me as much. I know this yet it still affects my everyday life. Sometimes its like I am thinking to myself the dishes can wait and 2 minutes later my feet are bringing me into the kitchen. Does this also happen to you? Sort of an out of body experience?

  5. I Am Not my OCD--I agree that I will probably always crave certainty about my health symptoms, but the huge chunks of my life that went missing because of the compulsing are a reminder to keep working on facing my fear.

    Angelina--Yeah, that out of body thing sounds familiar! I've been practicing going into my studio first thing in the morning instead of the computer, and it's like a magnetic pull to sit down at the computer, and then wonder what happened to the day.