Self-Fulfilling Prophecy: The OCD Tyrant!

Here’s a helpful cautionary tale from the modern folklore that is Star Wars.  It doesn’t matter if you’re not a fan of Star Wars, you’ll pick up the idea.  (Although it does matter if you’re not a fan of Star Wars – what on Earth is the matter with you!?!)

Anakin Skywalker is an heroic Jedi Knight who, for all his powers with the Force, harbours two personal struggles: one is a self-perceived guilt over the abandonment, and later death, of his mother; the other is that he is plagued by nightmares that the love of his life, centre of his universe, Natalie Portman (or Padme, as he likes to call her) is going to die in childbirth.  Influenced by the guilt he feels over his mother, and the fact that his marriage to Padme is secret (so he is even afflicted by guilt over his own feelings of love) he does not only fear that these nightmares shall come true, but that this, too, shall be his fault.

Right, now you’re probably thinking ‘wow, that’s a great story Baz, but (either) a) I already know it, I’ve seen the films, b) I couldn’t give a toss, (plus) c) what the hell has this got to do with a blog allegedly about the mental health condition Obsessive Compulsive Disorder, which was all very helpful and informative until you stopped bothering your arse even writing it at least a year ago?

Well, please – allow me to continue and to clarify.  Back to the story, and enter Chancellor Palpatine, a.k.a. the evil Sith Lord in disguise who is soon to become the tyrannical Emperor, oppressor of all liberty and hope.  A.k.a. the intrusive thoughts at the heart of OCD.  ‘Ahh,’ you all say, ‘he’s using it as a metaphor!’

Yeah, yeah, thanks for keeping up – let me get on with it.

The Chancellor / Emperor has befriended young Anakin for some time now, and has been subtly manipulating him to believe that he understands the troubled hero whereas no one else does, making him the only one that can truly be trusted.  So of course Anakin confides his fears to the Emperor, who then makes clear to him that not only are his irrational fears definitely going to come true! (cleverly reinforcing Anakin’s guilty feelings that what might go wrong is all his own fault), but that the only way he can stop this happening is to side with the Emperor and embark on an increasingly destructive set of actions which then actually result not only in the very things he has been fearing taking place, but also in the loss of everything else he loves, and the loss, effectively, of his own identity (replaced by something dark, corrupted, and destructive – Darth Vader).

Now, I’m not just telling you all this as an example of literary criticism, and presenting Star Wars: Revenge of the Sith as cinematic metaphorical depiction of how OCD can work (though it seems to work that way quite well, now that I’ve written it).  Rather my intention was to use it as an example of something that is key to the perpetuation of intrusive thoughts and their impact in OCD, or indeed other experiences of anxiety and worry: the self-fulfilling prophecy.

The only reason, ultimately, that everything goes so very badly wrong for Anakin, was because he was persuaded that he had to do something about his worry: and those very things that he did were the actual cause of his fears coming true.  I’ve spoken in blog articles before that the issue, when it comes to OCD, is not the thought (the ‘O’ – Obsession – component of OCD), but the response or reaction to this thought that we feel compelled (the ‘C’ component) to do about it.  The thought becomes the central problem in your conscious existence when you follow it, believe that it will be this problem, and so you try to stop it.  Things only go so badly wrong for you due to the measures that you carry out to prevent, change or nullify it: checking again and again that the door is locked; washing your hands if you touch a certain thing; avoiding seeing a certain food product in the shop; finding reassurance that the strange thing you just thought about is not the case, constructing arguments in your head about why it must not be the case.  It’s not the problem to have the nightmare: the problem is to listen to what the Emperor says you must do about.

This Star Wars example, this metaphor, cropped up in a therapy session of mine a year ago.  I had made certain progress at the time, but a small something occurred while I was watching a film (an activity that I enjoy a lot, but had been unable to consistently do for a couple of years at that point due to my OCD) and something I saw made me think of something, that linked to intrusive thoughts that I had been suffering.  I actually did pretty well – I was discomforted for a few days, but recognised that I could accept that and that there was no need to follow the thought and demonstrate why it was not a problem; no need to avoid watching another film until I had managed to demonstrate this to myself – because it was only going to become more than a temporary discomfort and become a mentally crippling problem if I tried to demonstrate this to myself, to challenge the thought through internal arguments which would escalate, and get out of control, if I believed that any of this was necessary.  My therapist was pleased with my response, with the insight, and laid bare the role of self-fulfilling prophecy in OCD, of recognising that is what it would become.

So, why am I writing about all this today, a year after that conversation, and about the same length of time since I last contributed to this blog?

In terms of recovery from OCD, I have been doing very well.  A month after that session last year I had a bad, bad downturn and was in what cognitive scientists call a ‘right fucking state’ for a few months.  But then in November / December I made a massive break-through, and a couple of brief slip-ups aside that I have sailed through well, this year I am pleased to say that I am doing much, much better – the best I have felt in four or five years.

In recent weeks however, I have noticed some warning signs.  Not so much of OCD – but of becoming overwhelmed by my own feelings, of ruminating on this, worrying about it.  I have experienced depression in the past as well as OCD and I have noticed that I am projecting the way things may pan out based upon those experiences: I have started applying certain negative interpretations to things happening around me, applying self-judgement as a result, ruminating over how I need to adjust my behaviour in order to avoid the path of depressive episodes before; to make sure that the faint whispers of OCD symptoms I’ve been hearing for a couple of weeks at the edges of my mind don’t grow into a problem…  Then, it struck me, as I opened the laptop today, to work on the book that I’m writing (hence, so little blog activity), and weave in the Anakin Skywalker self-fulfilling prophecy metaphor into the self-realisation of one of my characters, that the very way I am approaching my feelings is same thing.  It’s the Emperor, wearing a different outfit, and warning me what to do about a different nightmare.  I am feeling a bit down at the moment, but the way it shall become the disaster I fear, is by my trying to work out what to do about it.  There is only one thing I need to do: recognise the thought-distortions involved in my current thinking, take a step back, don’t judge and to be aware.

Very much advice Yoda would give, rather than the Emperor.

So I wrote this, to remind myself.  But also, because I hope that it is useful and helpful.  As I have said before, OCD is a disordered version of normal human cognitive processes: understanding what goes wrong, how it escalates and what can be done about it is useful for all of us.  Recognising the role of self-fulfilling prophecies, of thought distortions in our thinking when feeling anxious or down, is helpful, because they can be countered.

That’s great, you all say.  What are these thought-distortion thingys again?  Are they like Jedi mind tricks?

Ah, no.  They are something else.  And because this is getting long, and I’ve got a book to write, I shall leave it there, on that cliff-hanger.  But I shall be back very soon to explain their part in my current worries, and the part they play in all of our worries.  Best still, I’ll suggest what you can do about them.

Who tells you how you feel? You.

I don’t know where I’m going with this article as I start it, so hold on tight – it could end up anywhere.

It has been sometime since my last post, which means that the ongoing narrative about what OCD is, and the importance of it being understood (along with mental health issues as a whole) has somewhat drifted.  I feel that I should at least say something about where I have been the past four or five months, then work out where to pick up the thread.

I have been distracted from writing articles for this blog recently by taking a career-break from my job and working on a longer-form writing project (a novel, in fact.  Ooh – fancy!)  I have also been working very hard in therapy, making progress in my own personal mental health battle, and perhaps, ironically, that progress has taken some of the immediate urgency out of the blog writing – I don’t know.

During the last six weeks or so, there have been a number of things that have been gently prompting me with a reminder that I need to get a blog post done.  Among them: a grossly irresponsible documentary by BBC Panorama concerning hypothesised side-effects of SSRI medications (Selective Serotonin Reuptake Inhibitors – drugs used as part of the treatment for anxiety, depression, OCD, eating disorders and Body Dysmorphic Disorder); becoming riled and upset by a thoroughly ignorant arse berating me in the most twattish manner on social media, following my challenge of a ‘jokey’ OCD quiz on Facebook; someone else on twitter expressing their fear concerning her OCD diagnosis due to things that she had read in the media; and a post-it note attached to my laptop saying ‘Baz – You Need To Get A Blog Post Done!’

Where on earth do I start..?

Well, unfortunately, what has probably prompted me most is a motorway pile up of shitty experiences in the past month, which has seen a (temporary) halt in the writing of my novel, and a crash in both my mental and physical health.  Last month I commenced the long overdue process of trying to track down my estranged father, whom I had not seen since I was a teenager.  One of my first discoveries, four weeks ago, was that I had indeed waited too long: he died at the end of January this year, and neither I nor any of my siblings had been informed.

Understandably, this has been something of a shock; the waves of which are carrying a great many feelings stirred up from the deep and sending them crashing upon my waking shore.  These are feelings arising from complicated familial situations based in my childhood (mainly teenage) years that have had significant impact upon my emotional development, and are an integral part to one aspect of my work in therapy.  So it was of little surprise to my mental health key worker that OCD symptoms (some that I’d very much gotten past) reared up again.  These have subsequently interfered with the grieving process over my dad.  Luckily, to make it all easier, I was then admitted into London’s Royal Free Hospital for the fifth time since 2012 with an infection exacerbated by the serious autoimmune disease from which I suffer (and have referred to in an earlier article).  I’m home now, recovering.

I believe that there is a phrase for these kind of situations.  I can’t remember if it is ‘perfect storm’ or ‘taking the fucking piss.’  Either one shall do for now.

I considered making this blog post about those feelings stirred up in the wake of the news about my dad; about the unhappy situation when I was growing up and its relevance to some of my therapeutic work.  My hesitance around this is that the aim of the blog is to inform/educate about OCD and provide help for those experiencing or encountering it either personally or second hand, and I was unsure how helpful for others it would be.  I spoke to a good friend about this, just before I went into hospital a couple of weeks ago actually, as I was first sketching out this post, and she felt that it was perfectly valid to base the article on such a cathartic discharge – as it can still be helpful for people to see the importance of doing something with feelings that may be contributing to their mental health difficulties and, of course, helpful for me.

Ultimately, I have decided not to make a discussion of those particular feelings the central focus of this post (it may still come out in another post, or as part of a number of posts), but what my friend said has been influential on what I do want to say today.  Because she is right: what I am feeling and experiencing is what is relevant to my blog, not what I think I should have to be doing, saying or discussing.  And I realise that this ties up rather neatly to those earlier prompts to get a blog post done that I listed in the third main paragraph above.

Both the BBC Panorama show and the ignorant twat (who I don’t even know by the way) that berated me on social media are material enough for a blog post in themselves – one about the representation of mental health, and how important it is.  This is already a running theme throughout the articles in this blog however: I have discussed before the importance of responsible representation of mental health issues, and the harmful nature of misinformation, perpetuation of myths etc.  The Panorama programme was called – I shit you not – ‘Prescription For Murder’, and with a sensationalist disregard for facts and evidence, it presented the hypothesis that SSRI drugs may have such harmful effects upon a minority that take them, that perhaps even lead to killing, with a quality of analysis that would see me sacked from my job as a Research Analyst if I had handed it in to my boss.  The social media twat launched his attack on me after I challenged a Facebook quiz (entitled the ‘OCD Radar’) due to how harmful this misrepresentation of the illness can be.  But rather than thinking about how badly mental health issues were represented in each of these instances, I want to focus on the judgemental ownership of mental health issues that occurred in each case, and the prescriptive attitude towards the people actually experiencing mental illness.

In the Panorama case there was a great deal of irresponsibility in the implications made about how mental illness should or should not be treated.  Within the community of those affected by mental illness, the use of medication can be a touchy subject.  This is generally because (and am simplifying a bit here) on the whole, psychiatric practitioners tend to feel that what can make a greater long-term influence on recovery for anxiety, OCD, depression, are other therapies (e.g. appropriate talking therapies, CBT etc.) plus peer support, lifestyle and wellbeing choices, rather than just medication alone.  And, of course, there are side effects to the medications prescribed (SSRI’s or other types).  But before anyone panics, keep this in mind: there are side-effects to all medications.  The medications that I have to take for my physical illness have some genuinely horrible and rather serious side effects (in fact there are a couple of medications I have to take because of the side effects of others that I take!)  As a result (remember – I am simplifying) there is a phenomenon among those who suffer mental illness, sometimes known as pill-shaming, whereby using SSRIs, anti-depressants etc. is frowned upon and criticised.  So when that Panorama programme occurred, there was something of an outcry through social media among the large population for whom these medications make an essential positive difference (literally being life-saving in many cases).  Unfortunately, in turn, there was also something of a backlash against this, amongst those who have struggled with some of the side effects (not by massacring people, as Panorama carelessly implied) of SSRIs enough to not want them as part of their treatment.  They felt that the medication-defenders were criticising them.  The medication-defenders pointed out that they are often pill-shamed.  The makers of the Panorama show, not even interested in this side of the issue slunk off without a care.

The point is, whether you take medication or not is between you and your medical professional (be it GP, psychiatrist, therapist – whichever combination).  The most important person in recovering from mental illness is the person experiencing the mental illness.  You.  If a particular therapeutic combination is working for you (or indeed, if it really isn’t) then you are the person to know that, and should not be made to feel worried that you are in the wrong.  There is someone I know who during a medical where they work was told by the contracted doctor there that they it was wrong for them to have been taking anti-depressants for as long as they had!  Causing them distress and anxiety during the medical.  That particular doctor was being nothing short of unprofessional, and badly ill-informed, not being my friends own doctor or knowing their full case.

Take this parallel.  Think of how annoying it is if someone asks you who your favourite band is.  “Little Mix” you might say.  Or, “Slayer”, “Coldplay” – whoever – and their face twists in disgust or laughter.  They shake their heads.  “No,” they say, “that’s stupid, they’re childish/cheesy/crap!”  It could be your favourite film instead, or celebrity crush, I don’t know, anything.  Who are these people to tell you what your experience is!?  What you like or not?  That’s annoying right?  Now imagine someone telling you what your experience of mental illness is or should be, and what does or does not help you feel better!  That’s not annoying.  That’s insensitive, that’s distressing, that is dangerous.

Of course, there are parameters involved.  If you are being treated for anxiety by someone who tells you to sleep in a tree and eat nothing but Percy Pigs (they’re a British gelatine-based sweet for non UK readers – and you should try them), then actually, that probably isn’t going to help a great deal in the long term, even if you initially think it might.  You want informed approaches advised by qualified professionals.  But here’s a thing to consider.  There is not one approach, and there is varying evidence that qualified professionals can draw upon.  Mental illness is also a complex subject that these qualified professionals are still learning a lot about.  So within the parameters of legitimate help and treatment, there is variation, and there will be variation about what works or what combination works for one person to the next.  This is down to you, together with your doctor/psychiatrist/therapist to establish.  If CBT is working for you, and you don’t feel medication helps – great.  If CBT is not enough and there are other talking therapies that sort out the mess that feeds your anxiety/OCD/depression: good.  If you find that adding medication to the mix makes you better still, awesome.  There is no fixed rule.

So beyond the irresponsibility of the poor representation of certain issues, that Panorama show contributed to this dictating to and judgement of what people going through mental illness experience and how they can be helped – which frankly pissed me off.  The social media twat that berated me, well, yeah the argument was triggered by the poor representation of a mental health issue, and his views were most likely informed by other successive poor representations, but what really got me was the way the guy was telling me, someone that suffers OCD, what my attitude about it should be (that I should take it all a lot less seriously), and how that would help me be some kind of better person.

But the most important person that I want to reach out to in this post, is the person who posted on twitter, saying that she had been given a diagnosis of OCD, and that she was scared.  She had read about OCD online, she feared just how bad it could get, feared that she would never recover.  Oh I know that fear.  Each time there is an episode, the symptoms rear up again, that fear drives their resurgence.  This is it.  I’ve lost, I’ll never get better.

What I want to tell her, much that I am in a funk at the moment, is that it will get better.  I have seen in another (very good) blog post listing OCD myths that one of them is that sufferers can have good OCD days and bad OCD days.  Rather she says, it is always there but the key is learning to manage it.  That is her experience, and it is not wrong, and I am pleased that she has that management tool in her armoury – but from my own experience, I disagree.  It can, and does, go away.  Which one of us is right, which one is wrong?  Neither, both, whichever way you want to put it.  That’s not how it works.  Both of our experiences are real, and should be respected.  Just as there may be two people with the same physical illness, one may be treated in such a way that the condition can’t be gotten rid of but can be managed, whereas the other may recover completely.  For the twitter girl my advice is learn from the experiences of others, but remember that these are not fixed rules, so do not allow them to become fears or pressures.  Some people deal with recovery and management of OCD without feeling a pressure to get completely ‘better’, accepting that managing it well when it occurs is the aim.  Others, like me, are boosted in the fight by a therapist that insists full recovery is possible, and reading accounts that support that.  Remember, neither is right or wrong – there’s a lot of people in the world, with a lot of different experiences.

Yes OCD is scary and miserable, as I don’t need to tell her. But it is treatable, it is manageable, it does get better – whether that means being so well managed that you can carry on ok regardless, be it that it goes away for periods of time, even after it recurs, or be it that you can recover altogether.

And now this post has gotten very long, and I’m just going to stop.  It’s been more rambling than usual, but I hope that it is helpful in some way to someone out there, and yes – I hope that it is helpful to me.  I’m not feeling good right now, but I shall remember that this has been the case before, and strive for the recovery that is ever improving.

And I shall be back sooner, rather than later, as there is an important theme here which I want to pick up: Fixed Rules, and the part they play in our mental health.  I don’t just mean people diagnosed with OCD, anxiety, depression etc.  I mean in the mental health for all of us.  As I have said in the past, just as every person that has a body has physical health that can be anywhere on a good-bad spectrum at any given time, every person that has a mind has mental health, which moves and rests on an equivalent spectrum.  Understanding the part that Fixed Rules, and the other five Thought Distortions (which I shall introduce next time) is important to understanding, managing and dealing with that mental health – be you diagnosed with a mental illness or not.

Finally.  I wish I had seen my dad.


Team Baz – The mates in my corner

This past Saturday, 13th June 2017, I took part in an annual event run by the mental health charity CLASP, called Walking Out of Darkness.  This was a 10-mile walk (further than I thought, my legs would like to add) in London, along the Thames, starting and ending in Battersea Park.  This is the fourth year that CLASP (Counselling Life Advice Suicide Prevention) have run the event, and this time they also held one at the start of Mental Health Awareness week in Birmingham, before the London one closed the week, and have a third, summer event, in Weston Super-Mare on Saturday 24th June.

It was a great day all round, with a hugely supportive atmosphere, inspirational speakers and real belief in the CLASP slogan ‘you are not alone’ being true.  The importance of this motto for anyone experiencing mental illness or mental health difficulties cannot be understated.  One of the greatest facilitators of mental illness is the feeling of isolation, and the belief that you genuinely are and always shall be, alone.  I did not feel so on Saturday.  As well as about 800 others, who genuinely felt like the most positive community to be a member of in the world, 12 friends from work and beyond came on the walk with me.  Now, they all had their own motivations of course, but I felt their presence personally as being much welcomed friendship and support.

It is about the value of such support from friends that I want to talk today, and specifically with reference to the ‘In Your Corner’ campaign currently being run by Time to Change.  Time to Change are an organisation that focus on challenging mental health discrimination and stigma, jointly run by the charities Rethink Mental Illness and Mind.  The focus of the campaign is about the mates in your corner, the ones who prove the CLASP motto of you not being alone, the friends who are there for you, who help you survive, help you win, the fight against the isolating monster of mental illness.  I am lucky enough to have such mates in my corner.

There’s so many I could talk about.  Today I shall mention three of them.

When I first opened up about my – I don’t know, let’s call it ‘remission’, my collapse back into the worst sustained period of OCD I’ve had – a couple of years ago, it was at work.  I was in an appalling mess, and I’m still amazed that I was managing to get to work at all.  Or to get out of bed, to stay alive for that matter.  My project manager and line manager were amazing: I’m lucky to work somewhere that has a very understanding and supportive management, and in a team that are very much like a ‘work family’.  One of this family, Zoe, had picked up very fast, despite my efforts to appear otherwise, on the fact that I was certainly not myself.  Usually in these blogs I give people a comical change of name (I considered DJ Z-Box for Zoe), but I think today those that I mention deserve the credit of their names.  In a state whereby I was falling apart at any prodding at all, I opened up to Zoe completely.  And what a relief it felt after all these years of keeping such episodes, the nature of them, closely concealed from others.  It was, it is, almost impossible to explain what I was experiencing.  After all , how many chapters of this blog are we into?, and I still don’t think that I’ve succeeded in relating it.  But Zoe allowed me that ambiguity without any insistence to fully understand it, with no insistence that we had to sit down and sort this out there and then.  She did understand of course – she understood what this was doing to me and that it was real, and that is all she needed to understand.  She understood that it wasn’t something she could just give an answer to, or tell me not to worry about and it would be solved, she didn’t gloss over it.  But she did also make clear that I could, I would get better, with the right time and support, and that I was not alone, no matter how I felt.  She made it clear that I was still Baz, and she was still my friend.  Zoe talked to me about getting help, and within a day we’d found the private organisation which I am still attending for CBT and gotten my first appointment for the next day.

There are so many instances of essential moments that she was there for me, but the one that really stays with me occurred about four months later.  As I say, this has been the most severe episode of OCD that I have endured in my life, and after some initial progress, I took a big downward turn.  A particularly bleak weekend and calls to the Samaritans had led to medical intervention by the local psychiatric crisis team.  Monday came around and I was to go off to be assessed at the psychiatric hospital in Burnt Oak, Edgware.  I did actually go to work first thing, I just couldn’t bare being on my own, and despite being about to go and get further help, I was scared.  I was in as low and dark a place I ever have been, so it was difficult to find optimism, but also the very prospect of those bleak, grey, psychiatric hospital grounds and the difficult conversation I was about to have was scaring me.  This may come as a surprise to anyone who has known me a long time, as only my late mum was aware of this, but I spent a very brief visit to such a facility a few months after I graduated from university.  It was voluntary, they were there to help and it was a long way wide of the horrors depicted in One Flew Over the Cuckoo’s Nest, but it was a miserable stay which I never want to experience again.  In that instance I discharged myself very soon because I simply couldn’t deal with it, and fortunately as an out-patient was doing much better within a few months.  I did not know what was going to happen this time.  But as I was putting my coat on, Zoe came to my desk and simply suggested how about she come with me.  I’ve attended a lot of hospital visits in the past five years with my complex physical health, including for some quite worrying procedures, which I’ve managed fine by myself.  There was no hesitation in my tremulous, grateful nod to her offer on this occasion.

It was both a simple and powerful thing that she offered.  Just to be there.  To talk to me on the train about whatever she would normally talk to me about, even though I was not much capable of contributing; to wait during the assessment; to hug me after as I cried; to take me for a milkshake (my first ever milkshake – can you believe that!).  Powerful because she was showing me that I was not alone.  Simple, because what was she doing?  She was being my friend, as always.

And all of my friends have stayed this way, through all of this.  No impatience that I be better by now, no demands that I explain to them what exactly is going on.  They just stay my friends.  They are ready to spot when a reply of ‘ok’ to the routine enquiry of ‘morning, how are you?’ is delivered without conviction, and to offer their presence and kindness.  So reassured am I by their support, that I can now seek help when I need it.  I have sent messages to my friend Beth at weekends, evenings, days when we’ve not both been in the same office, because I know she wants me not to try going alone when I am struggling.   She has been on the phone so quickly after, or arranged lunch the next day so we can work through the struggle.  She takes me through what I have been doing and learning in therapy – I tell her all about it – and she helps me work through it again, refresh and reinforce it.  She doesn’t come in to try and fix the problem, she comes in to remind me of what I already know, to help me fix it myself, and realise how far that I have come.  Similarly my friend Melissa lets me explain to her the principles of what I do in therapy, and in so doing reinforce it for myself.  When I am getting in a mess, I know I can speak to her at any time, and she explains it back to me, clarifying it and making clear how much she cares about me and much better she can see that I am doing – that the bad period I am having is a temporary lapse.  Then, like Beth, like Zoe, she will take the piss out of me and draw the real Baz out.

I could go on with example after example, but here is the core of what Zoe, Beth, Melissa, every single one of my friends at work, those who came to Walking Out of Darkness, my mates who regularly go out for burger with me, my friends at the other end of the country who are always there to talk – team Baz, the mates in my corner – are doing for me.  They are treating me as me.    They are accepting the illness I have as an illness, and seeing the real me.  Keeping the real Baz alive.  Because when I am unwell, it feels like I am not: I’m not there and never will be again.  But they help me know that I – the real Baz – am still alive, still there, which means that this shit is not me, and that I shall win.  Therapy is only part of what is getting me better: the mates in my corner are swinging the fight my way.  Last Saturday, in that crowd, at Walking Out of Darkness, that’s what I could see all around me.  People who were not their illness, not their problems, and the friends who were helping  to keep them that way.  It’s something we can all do for each other, whatever the circumstances.  Turn to your friends if you are struggling.  Look out for your friends if you think they are struggling.

Cheers, and my heartfelt thanks to team Baz all over the UK!

If you would like to learn more about the work of CLASP please see, @claspcharity on twitter, CLASP Counselling Life Advice Suicide Prevention community on Facebook.  For more about Time for Change, their In Your Corner campaign (#inyourcorner) and their other work please see , @TimetoChange on twitter, Time to Change on Facebook.

OCD – The Opportunistic Troll

So, it’s been a while since the last entry in this OCD story of mine, and for those who have been following the blog, it feels like I need to open up with an American drama series style ‘last-time on Sketches by Baz’ sequence of key points from the last few episodes.  Basically those key points were:

  • In OCD, despite all appearances, the intrusive thoughts are not the problem – it is the process of attributing an alarming significance to these thoughts, and the subsequent defensive reaction
  • By disengaging from that defensive reaction – be it washing hands, checking things, making lists, generating counter-thoughts and seeking validating arguments – and letting the thoughts be, they lose their power
  • This is all good news – but unfortunately the reaction is compulsive, deeply unpleasant and doing all this is, while achievable, bloody difficult

I’ve actually just looked back through the last few articles from late December and early January.  Largely because I need to tell myself all this – because in the last few weeks I’ve had a bit of a crash in my recovery and am currently feeling really bloody awful.

What I want to explain is that this could be a crucial period in my battle, and it could actually be a positive thing, no matter how difficult that is to believe this very minute.  Recently I have made a lot of achievements in overcoming my illness.  Part of my current problem may have come about by giving the OCD a window of opportunity by the very act of reviewing my achievements and checking that they are stable.  While the OCD has indeed taken this opportunity, it has made clear a characteristic about itself that my therapists say I can use to my own advantage.

Ok, first let me give you an example of a gain I have achieved over the OCD.

I had discussed in CBT this helpful analogy.   When I first fell in love with a couple of my favourite Pink Floyd albums, my copies were tapes (kids – use Wikipedia to look up audio tapes), copied from fairly old LP’s (vinyl records kids – you’re not bloody cool if you don’t know what they are!)  So as well as the music, there were a lot of crackles, pops, a couple of places where the needle on the record jumped a little.  Does this mean that it ruined the experience of listening to the albums?  No.  Because I focused on the music.  I could still process the beauty of the music in and of itself.  I was long at the stage where by I did not process the crackles and pops at all.

The crackles and pops, are not part of the music.  Just as my horrible intrusive thoughts are not part of the things in life that I have been struggling to enjoy.  Whatever the thoughts tell me, what I enjoy, what I am, life – it is still beautiful and enjoyable if I focus on it, and not on the interference.  And if I don’t focus on that inference, I’ll stop being aware of it.

Understanding the truth of this analogy makes me feel really good.  Then, a day after talking about this in CBT recently, I had a wobble.  I thought, does this analogy work in my particular case?  Is it different because…?  Does that mean what I thought I had achieved is wrong?  If so then…?  What if…?  But… but… but…  Before you knew it the intrusive thoughts were using my gain against me.

So what had happened?  It’s not actually that complicated.  You could say that because I had achieved something, the OCD threw a noisy strop.  I stopped responding to it, so it shouted louder.  You can demonstrate this basic kind of mechanism in behaviourist psychology.  If you have a mouse (Gerald) who lives in a cage where there is a lever and he presses the lever, only to have a pellet of food delivered, he’s going to press the lever again.  By delivering the food each time Gerald presses the lever, you have conditioned a behaviour in him.  My intrusive thoughts, while not as cute as Gerald, have been behaving the same way.  They pop into my head, I react to them.  In reacting to them I have reinforced their occurrence, so like Gerald with his lever they keep coming back into my head demanding attention.  Now, if you stop delivering the pellet of food to Gerald, what does he do?  Does he think ‘oh, stuff it then’, and wander off, taking no further interest in the lever.  Does he buggery!  He presses it, presses it again – sooner than he normally would, and goes briefly berserk, pressing it with heightened regular intensity.  Where is the food he’s conditioned to expect!?  Where, where!?  Press, press press!  Eventually, of course, he gives up.  And that’s what the OCD does.  Shouts, jumps up and down, causes a ruckus: ‘where is my reaction!?’

Having achieved something over the OCD, unfortunately, I gave it an opportunity, an opening, by kind of safety-checking my thoughts and feelings.  ‘I’ve made an achievement, is it ok now?  Is my achievement stable?’  Doing that was just enough of an opportunity for the OCD to get its foot in the door, and shout desperately ‘no Baz, your achievement is shite!  You’re shite!  And you’ve got stupid hair!’

What is important to recognise however, is not just that the OCD is opportunistic, not just that it is reacting against achievements I’ve made.  It is the manner in which it is reacting.  It is a wind-up.  It is acting just like an internet troll: its message (the content of the thoughts) don’t matter, it has no actual argument of its own, all that matters is its intention: to upset met.  Trying to provoke a reaction from me.  It just wants its pellet of food.

So if you say something good, something that you have achieved, something you deserve to be happy about on twitter, and a troll starts sending through messages that amount to saying your achievement is crap, that you are crap, what do you do?  Argue with them?  Does that make them go away?  No.  Just because they say you should worry about the validity of your achievement, should you worry?  Should you try to explain to them?  No.

Understanding this character of the OCD will help me win.  I’ve had a bad few weeks, and have received excellent help in some pretty intensive therapy sessions, where it already has helped me, just I’ve then slipped a bit again.  These troll like thoughts… pouncing on my own safety checking like unscrupulous salesmen, con men, tricksters employing suggestion and implication to get to me to doubt myself, tempt me back in to engaging with them…  It’s difficult.  But knowing that that’s all they are, trolls – that I can’t win by engaging with them and justifying myself, that there is no onus on me do so, it will help me win.  They have no argument to present, and my achievements are real.

Be back soon with an article about how valuable the friends in my corner supporting me through my illness are.


And by pouncing on my own safety checking like an unscrupulous salesman, a con-man or a trickster, to use suggestion and implication, getting me to doubt myself, it is currently getting that reaction.

Use the Bechdel Test to rate films and challenge the film-makers

As I said at the end of the last article, I’m taking a break today from the ongoing narrative about mental health issues, to talk about a feminist issue in film that I care about a lot.

It is not just because I am Carey Mulligan’s number one fan that I was so happy about the release of the Sarah Gavron-directed Suffragette, in 2015.  It was also because I am a feminist (yes, feminist, not ‘male-feminist’).  It was because I hope that many people watched that film and did not just get angry about issues depicted being from such recent history, but also became passionate to challenge inequality issues that exist right now.  I felt it was an important film at an important time.  Hopefully together with such events as the recent Women’s marches; the launch of the Women’s Equality Party in the UK; the UN’s solidarity movement He For She (@HeforShe) as championed by Emma Watson; and the excellent, accessible, online media platform The Pool (@thepooluk) co-founded by Sam Barker and Lauren Laverne in 2015, there’s a growing awareness and demystification of feminism among the everyday population; what it is, and why it is so important to us all.  Then again, maybe I’m just being naïve.

Whether I am being naïve or not, the continued existence of the inequalities and poor attitudes faced by women and girls, is a matter for urgent, continuing, conversation and challenge.  Not least in the film industry, for the cultural representation of women and girls, and the artistic and industry opportunities within, can be both a good reflection of inequalities and attitudes that exist in wider society, and provide opportunities to represent, inspire and normalise equality and healthier attitudes.

There are key Hollywood figures speaking up about the issue.  Geena Davis is producing a documentary film in partnership with CreativeChaos on gender inequality in Hollywood; Jennifer Lawrence wrote an essay in 2015 for Lena Dunham’s Lemmy Letter newsletter expressing anger at the gender pay gap in the film industry (a good example being the considerable gap between herself and her male co-stars in 2013’s American Hustle); while Reese Witherspoon and Jodie Foster are among other major figures that have contributed to the debate since then, also citing limited opportunities for female directors.

Last week Emma Stone (an excellent actor) became the seventh winner of the best actress since the year 2000 to be aged in her 20’s, compared to just one male in that age bracket picking up best actor gong in that time, possibly indicating a greater value on age and attractiveness being placed on women in Hollywood; and / or limited opportunities for older actresses.  As well as disproportionate opportunities for female talent, there is a disproportionate representation of nudity when it comes to female performers.  The 2016 Mount Saint Mary’s University, California, Annual Report on Status of Women showed that 26% of female characters in the US Box Office top 100 films for 2014 appeared nude or partially nude, compared to 9% of male characters.

All in all, it was great to see Suffragette, a film about equality struggles faced by women, featuring a number of great female performers of varying ages, directed by a female director.  And, of course, it passed the Bechdel test.

Whoah there.  The who, what, which is that you say, Baz?

Some of you may be familiar with the Bechdel test, but many people I speak to (feminists included) have not, so here it is.  Named after the American cartoon satirist Alison Bechdel, the test is a simple one to apply to a film, and you would hope it should be easy to pass.  To do so, all the film requires is to have a minimum of two named female characters, who at some point have at least one conversation, which is not about a male character.  Not much to ask is it.

According to 42% of films fail this test.  I actually thought it was even more, but nonetheless, that does not sound good enough to me.

Now there are limitations to the Bechdel test of course.  For example, what constitutes a conversation?  The female characters could still be appallingly two-dimensional or stereotyped, and the film could still be sexist.  But it is a least a starting point to measure disproportionate representation.

There are other tests – such as the Mako Mori test (named for a character in the 2013 film Pacific Rim).  To pass this test, a film needs to have at least one female character, who has her own narrative arc, which is independent of any male characters story arc.  Ideally, and quite reasonably, films should be passing both these tests (in my personal opinion).

Now, I am sure that there are many more experienced bloggers and film writers who have discussed the Bechdel test, analysed it’s various merits and the wider issue in depth.  That is not exactly what I have produced this article for though.  What I would like to do is to use the Bechdel test to help stimulate change.

There are many sources for us film fans to judge the quality of films, or whether they might personally appeal.  IMdB, Rotten Tomatoes, Empire Magazine, Total Film magazine, Sight & Sound, Little White Lies etc., etc.  There are many insightful and well written reviews.  There are many ratings for films (sometimes clashing – opinion and interpretation are a big part of this art form).  For example, Empire and many others rate films on a scale of 1 – 5 stars.

So what I am thinking is, how difficult would it be to add one small thing: Bechdel test passed – yes/no?  Apart from anything else, it wouldn’t be long before a lot more people were aware of what the Bechdel test was, and the point of it.  Then be thinking more about the importance of it.  Yes, the Bechdel test may be limited – but it is a starting point, and every little helps.  It just may make the conversation louder, and instigate the use of ever more effective tests, and prompt demands for action to take place.  So why not?

Thus I would like anyone who agrees with me to help lay down this challenge to Empire Magazine (; Total Film magazine (; Sight & Sound magazine (; Little White Lies (; Guardian Film, or whatever publication you take you film review and ratings from, here in the UK or wherever else you are reading this (otherwise I’m going to look silly trying to do it on my own!).  Email them.  Tweet them.  Annoy them.  Make this small but important addition to your film rating.  Bechdel test pass: yes/no.

Change it Hollywood!  Help them change it British Film Press!

Thanks for reading – the next article shall return to my ongoing narrative about Obsessive Compulsive Disorder and broader issues around mental health.

OCD – is it a bit weird or are we all ‘a bit OCD’?

In the article ‘Finding the D in the OCD’, I spoke of how the disordered component in OCD is the compulsive interpretation and reaction to intrusive thoughts.  This is what keeps the illness going, and although if feels as if the intrusive thought is what is wrong and what is hurting, it is actually this reaction.  It is this reaction that CBT targets, but it’s not an easy thing to challenge.  Do not underestimate how strong the disordered compulsion is.  Just think about the word: compulsion.  Something that you are compelled to do, that you have to do.  In her book ‘Am I Normal Yet?’ Holly Bourne equates it to the physical urge to urinate.  It is a deep and irresistible urge, which takes over and can’t just be ignored.  It is not something that you choose to do, mistakenly, for the best.  It is not a habitual peculiarity that becomes irritating and difficult to break.  It was no irritating peculiarity which influenced a couple of (admittedly half-arsed, but nonetheless despairingly intentioned) suicide attempts in my early twenties.

It is not easy to explain how much these disordered interpretations and reactions feel a part of you; how undeniable the unsettled, distorted state of mind and self-perception feels, as most people have probably never experienced anything like it.  Hmm, apart from… most people probably have experienced something like it.

As I also mentioned before, everybody has thousands of thoughts passing through their minds a day, and some of those thoughts will be weird or unpleasant, incongruent and unwanted.  Let’s just pluck a few examples out the air:

You’re waiting for a train and among myriad thoughts passing through the background scenery of your mind, this one pops up: ‘what if I jump in front of the train?’

You’re eating your tea/dinner/supper (all regional interpretations catered for here) and for no good reason as you stab your fork into some carrots you have the mental image of a rabbit, doing a poo, on your plate.  Eurgh!

You are walking past a playground when you find a dropped hat.  You pick it up, thinking maybe to hand it in somewhere, then out of nowhere think – ‘what if the child who dropped this has been kidnapped and murdered?!  What if everyone thinks I’ve done that?   I’ve got the hat!!’

Think, just for a moment.  These are just a few examples I’ve made up, out of near infinite possibilities of potential thoughts.  Just think – you’ll find your own examples that all of you will have at some time experienced.  Many of which, you shall have forgotten.

Likewise, everybody experiences unpleasant emotional reactions to thoughts or external events.  Everybody gets trapped in worry-loops about something in particular, sometimes rational, but unaided by the worry, sometimes thoroughly irrational.  In relation to thee examples of unwanted thoughts above, consider these reactions:

While you may think a surprised ‘blimey’ on the train station platform, and take a step back, you may also inspect the thought – ‘why did I think that?  Can I control urges to jump?  I’m not suicidal – am I?’

Where one person may well laugh at the idea of a rabbit doing a poo (each to their own), another may feel sickened, disgusted.  Put off their tea, or even for a while put off carrots.

You may shrug at the thought of being accused of kidnap and murder (unlikely), and carry on; or you may drop the hat, then worry for the next twenty minutes that your DNA is on it.  Or that if you told someone about the thought, they’d wonder why you were hanging around playgrounds.

Also everybody sometimes employs some personal set of rules to manage how comfortable they feel about something.  You knock one had as you walking through the shop, you feel like knocking the other one, to balance it out.  You have in your kitchen a hand towel (for drying hands only), a tea-towel (for drying dishes only) and a dish cloth (for wiping down the work surface only).  And you do not mix them up!!  You get fidgety and irritated when someone visits and uses the wrong one for the wrong thing.

Again, look through your own life, and you’ll find some of your own examples, at some point, somewhere.

So… does this mean that OCD actually affects everybody?  Aha, thanks for asking: No!  Absolutely not.  The often casually banded phrases of ‘I’m a little bit OCD’, and ‘everybody’s a bit OCD aren’t they?’ are part of the harmful myths to which I’ve referred before, which perpetuate a misunderstanding and belittling of a very serious illness, that affects between 1%-2% of the population of the UK and USA ( figures).

You may be thinking ‘OK Baz, fair enough mate, but, um, you do appear to have just slightly contradicted yourself by saying everyone experiences these thoughts and reactions, but it’s wrong to say everyone is a bit OCD…’  Yeah, don’t worry, there’s no contradiction.

What I’ve intended to demonstrate here is that these odd, unwanted thoughts, these anxious interpretations of things, weirdly disproportionate emotional reactions, ways of maintaining our own mental comfort or order are totally normal.  It is all part of normal human cognition, emotion and behaviour, and very valuable it is too, even when sometimes confusing or worrying.  But just as everybody sneezes and coughs, it doesn’t mean that they have a cold.  Just as when people have colds, it doesn’t mean they have pneumonia; or it doesn’t mean they have a serious, chronic and potentially terminal health condition.

What I am getting at here is that OCD, however it may appear, is not weird.  There is a disordered severity to what otherwise could be a normal reaction, to a thought, resulting in attention assigning wrongly significant interpretations to thoughts and behaviours.  In themselves, the processes involved are normal.  Not everyone has it, but as with all mental illness, OCD is normal human thoughts and behaviours becoming unhealthily detrimental.

Realising this is very important to understanding, accepting, and dealing with mental health.  And it is important for everyone.  Because, just as with physical health, while not everyone has a mental illness, everyone has mental health.  This health is on a spectrum, not fixed in one place.  Mental health can move up and down this spectrum, changing to more or less well, for everybody.  So understanding it, is important for us all.

Thanks for reading.  The next article shall be about an important feminist issue in film and culture – and a social campaign that I am going to attempt to start!  I shall return to the continuing narrative regarding OCD and mental health in the article after that.







An inspiration to fight on

I had planned to produce the next post in my ongoing narrative about OCD by the close of 2016.  Truth be told, I started writing it yesterday, then started re-writing it today.  I’m a bit stuck.  After growing anxious and disillusioned by this, I’ve decided that it’s ok.  In therapy I’m taught to focus on what I have achieved – and I have achieved something by starting the narrative.  The next part will come right, and I’ll post it soon enough.

However, I still wanted to post something by the end of the week.  It’s traditional as we come to the end of the year to reflect and look forward.  I hear and read a lot of people saying that 2016 has been a bad year; either personally, in terms of celebrated artists and entertainers passing away, divisive political votes, the triumph of those propelled by a rhetoric of hatred, refugee crises and a feeling that the peoples of the world are being driven apart.

I, personally, have had a shitty couple of years.  The most difficult period of mental illness has, excuse my language, fucked me over no end.  But I did start making progress in a difficult battle in 2016.  For those of you that are friends of mine on Facebook, you would have seen a rather emotional post a couple of weeks ago, celebrating that I had made a significant step forward in my recovery.  I genuinely was very emotional, realising just so strongly that I can win, that I will get better, and I am getting close.  My therapist told me that I am right to celebrate that.

So it has been quite difficult to swallow having had a more difficult patch over the past week.  Then something very sad happened, and despite it being very sad, I think it helps remind me not to think of this wobble as a backward step, and difficult as it is, to remember my strength and that I am getting closer to winning.

Last night the actress, author and mental health advocate Carrie Fisher died, aged 60, and I am deeply saddened.

Star Wars has been a massive, positive, part of my life; as indeed, it has been a massive, positive part of our culture for the past 40 years.  Aged seven, Princess Leia was the first love of my life.  But what I have to say here is more than a fan-boy lament for a beautiful princess.

Leia is far more than a beautiful princess.  She endured wrongs, and loss, and pain, but stood stronger for them, never giving up hope, fighting for what was right and just with a fierce independence, influencing those around her to find their best selves and move forward.  I believe in that character as a cultural and feminist icon, who influenced millions in a hugely positive way.

The power of the character worked, because those qualities and values were Carries Fishers, and this great actress was strong and funny and true.  She was alll this in the grip of a bi-polar disorder that rather than bowing under and hiding from (which would be understandable), she stood up to and spoke honestly about.  She did so with a honest frankness, and a fuck-you attitude: she accepted the fight she’d been given, did not back down from it or any other, whilst remaining herself, her funny, don’t give-a-shit self who did not care what anyone thought of her.  This brilliant self was an amazing example to the millions who loved her; an example to be yourself and stand up for yourself, to speak out about the struggle and do not give up, just like the rebel princess she portrayed.

So I’m going to speak up honestly about how I feel this week – not good.  And I’ve not produced the blog article I wanted.  But I will endure, I will fight on.  My recent emotional celebration was not in vain.  If I stand up to it, and believe that I am nearly better, I will get there soon.  Thankyou Carrie for the example you led by, and the inspiration to others to speak out about their mental health.

And thankyou Leia for showing what you do when confronted by darkness.

R.I.P. Carrie Fisher.  May the Force be with you, always.

Finding the ‘D’ in the ‘OCD’

It’s not about the content, it’s about the process.

This is something my CBT therapist discusses with me a lot.  He’s pleased that recently I’ve been attending OCD support groups and Bryony Gordon’s excellent Mental Health Mates meet-ups; things I’d have previously shied away from.  We’ve discussed the therapeutic benefits, amongst which is finding the similarities with others who overtly, at least, seem to experience something very different to me.  Realising that the similarities lie in the process of how the illness works, not the content of thoughts and scenarios experienced, is a very valuable thing indeed.   For the more that you realise that the content of intrusive thoughts does not matter, the closer to recovery you come.

Let’s strip OCD down to the basics.  Meet the stars of today’s two made up examples: Buffy and Davros (what?!  That’s their names, ok?).  Buffy loves going jogging, but has been terrorised by this intrusive thought: that when she runs along the street and encounters a little girl playing on her scooter, she’s going to violently shove that little girl out of the way, into the road, under the path of a speeding van.  She is horrified by this image, appalled that she has thought it, and terrified about why she has thought it.  Is there something bad in her?  Is she actually going to do that?  She can’t get rid of the image, and  she stops going running, or even walking in the street.

Davros doesn’t understand Buffy’s problem at all, and wishes that was all he had to worry about.  His anxiety has gotten out of control since he nearly left the house with the kitchen tap running.  He turned it off, but then turned it on and off again to be sure.  He finished getting ready to go out, but then checked the tap again, turning it on and off again twice more.  Getting to the front door, he thought, what if he left the bathroom tap on as well?  So he went back, turned that on and off again three times to be sure of that too.  Feeling better he finally left, but now he keeps thinking about the incident.  Before he knows it, he is struggling to ever leave the house or any room without turning taps, light switches, all sorts, on and off three times; and his anxiety about it and how weird it is, is making him feel sick.  Buffy hears about this and thinks it’s stupid.  Why worry about that?  It’s not like he’s being terrorised by images of pushing little girls in the road all day long, which might mean she has evil impulses!

The scenarios differ in content, but the process of Buffy and Davros’ problems are the same.  There is a thought that invades their minds (‘push girl in front of van’, and ‘left tap running’).  This thought glares the spotlight of each ones attention, gets trapped in their minds, like a song you can’t stop replaying in your head.

To try to neutralise this obsessive thought, both carry out a reactive behaviour.  Even though she loves running, Buffy stops going.  When this doesn’t work she even stops walking in busy streets.  Davros checks all the taps.  He checks excessively by turning them on and off three times each.  When this doesn’t work, he starts checking all manner of things, turning them off multiple more times.  This is a compulsive behaviour.

Ok, but last time I talked about mental images that upset me, and about abstract misery regarding the concept of humour.  They were obsessive thoughts, sure, but where was the compulsive element?  These type of OCD experiences are sometimes referred to under the umbrella term ‘pure O’, meaning pure obsession.  It is a term that I dislike for a couple of reasons.  Firstly it sounds to me like the title of a porn video!  Secondly, it is misleading, as there is a very strong compulsive element in terms of my reactions to the obsessive thoughts.  For a start, I do carry out overt behaviours, such as avoidance.  Also, the behaviours don’t have to be overt – they can be internal, mental.  In my case I try to transform the images to make them more acceptable or manageable.  Or I try to justify reassuring arguments that I construct to deal with the obsessive abstract terrors; try to ‘solve’ or ‘clean’ the thoughts.  Inn Buffy’s case she tries to stop the image, or questions the reason for it.

However, the real compulsive element in all cases, is not just found in the action carried out to manage the situation, but also the initial reaction to the thought.  This is a very important point in understanding and fighting the illness.  Because this negative reaction involves an interpretation of the original thought.  Buffy thinks ‘that’s horrible – but why did I think it; what if I actually do it;I must not do that; does it mean there is something bad in me; what if I can never walk in a street again?’.  Davros thinks ’how do I know I turned off the tap if I forgot before; why am I still worried about it; I must not let this happen; why did it feel better after three times; what if I can never just do things first time again’.  These are thoughts-about-thoughts – meta-cognitions.  They tell you that you need to do something about the thought.  Now.  NOW!!  They tell you the thought is dangerous, frightening, disgusting – do something about it, neutralise it, NOW, and don’t stop until it is gone.

And how do you make the thought gone?  Do you try to ignore it?  No, no, no.  Ok, you need to keep acting out sets of behaviours or counter thoughts until you find the right one to stop it, right?  Do you arse! (if you are reading outside the UK, this translates as ‘most certainly not’).  Look at Buffy and Davros’ examples.  The more they do, the worse it gets.  Oh, ok, shit.  So what do you do to stop them?

Well – you don’t.

What?!  But… surely…. What?!

What I mean, is that you don’t try to stop them.  And also, you can’t stop them.  But don’t worry, you don’t need to stop them.

You see, the thoughts themselves are not the problem.  They are just thoughts.  No matter how weird or unpleasant.  Everyone has thousands of thoughts passing through their minds every minute, and some of them are, well, weird and unpleasant.  Having the thoughts is not the disordered component in OCD.  How could it be, when the thoughts themselves can be about anything at all?  What is disordered is the reaction to the thoughts.  The severity of that compulsive reaction, that alarmed interpretation, keeps the thought in the spotlight of attention.  The meta-cognition which demands corrective behaviour, a mental solving of a problem, that doesn’t actually exist, maintains the obsessive problem in a vicious cycle.

This is the reason that, in cognitive-neuropsychology terminology, OCD is such a total, utter, bastard.  But while it is a long, long way from easy, once you fully get to grips with where the disorder truly lies – in the process, not the content – then you can start working towards dealing with it effectively.

How OCD first invaded my mind, and other stories

As I explained last time, the experience of OCD is massively varied.  Not only does it vary from person to person, but within one person’s experience it changes too.  This is an important point to emphasise – as next time I’ll discuss how it is not the content of the thoughts that is important, but the process.  Today, to provide that discussion with some context and to demonstrate OCDs variable nature, I’m going to take you on a tour of the earliest years of my illness.  Believe me – this is deeply uncomfortable.

14 -16 years old: Contamination

It began with a problem at school.  Bullying?  Girls?  Long division?  No.  Acid.

I don’t mean acid as in LSD or late 80s dance music (‘this is aciiieed!’).  I mean hydrochloric, sulfuric… whatever acid as used in chemistry class.  Although I believe that acid tends to announce is presence on skin quite proudly, I felt deeply uncomfortable after science class.  What if the chemicals were on my hands?  On my clothes?  On my school bag?  Within no time at all, just going to school resulted in a feeling of entering a contaminated environment.  And I mean feeling: I experienced a highly sensitive physical discomfort, like walking in to lukewarm, dirty, water.  My home life and school life were wrenched apart – I had to keep them separate.  Anything associated with school took on this irradiated quality, humming with a stale warm glow, like the halo around people who had eaten porridge in the old Ready Break adverts (showing your age Baz – tell them to look it up on YouTube).  When I got home I would remove my uniform, store it, my school bag and books in an isolated location which could not be touched, then go straight into the bathroom to thoroughly wash.  While my school work went to shit (I didn’t do any homework) and social life was affected, I managed the situation up quite well, I thought.  When I went into the sixth form, which was safely separate to the rest of the school, the problem faded away.  It was not until years later, that I told anyone about all this, or associated it at all with what was to come.

16-22 years old: mental imagery

Gradually over these years OCD properly took hold, and took the form of bizarre mental images that intruded upon my minds eye like a waking nightmare.  Polluting and infecting all other mental imagery, they’d twist and distort my imagination.  This is still the most common form of the illness I experience to this day, when I have relapses.

The problem would come and go, be more manageable sometimes or worse others, and last varying lengths of time.  The frequency, duration and severity gradually increased over a few years, until by the age of 21 it was near constant and having a severely distressing impact.  I responded to the images with compulsive feelings of disgust, repulsion and severe upset.  Their presence was feared and delivered an extreme sense of discomfort and wrongness, accompanied by apparent physical sensations: similar to the irradiated contamination I described above, and a warm sickly sensation in my head like a lumpy ooze bubbling under my skull, or rock jammed in my brain.

I was also stricken by a guilt – a responsibility, a need to seek reassurance from myself that I could fix this this.  Try to restructure the mental images, arrange them all as if solving a puzzle to get back to normal.  To have a ‘clear’ or ‘clean’ head again.  I tried to avoid physical or topical stimuli that may trigger the images.  My reaction to encountering such stimuli was as if to an electric shock, or an alarming, explosive sound.  They commanded my attention, demanded reassurance and resolution.

The form that the images themselves took changed every couple of years after they started.  First it was cigarette butts.  I’d be reading a book, picturing a scene – and there was a mound of cigarette butts.  Thinking of nothing in particular – there was a rotting cigarette butt floating in my head.  That changed as the problem intensified, both in frequency and severity.  The first change came when I’d poked my hand down the side of the armchair to retrieve a dropped pen, and recoiled in disgust at feeling food crumbs that had escaped and gathered there over time.  Now thoughts and images invaded my head with a force I’d not experienced before – ‘imagine that mess mixed with cigarette butts; imagine all little things in the world dropped and mixing with that mess; imagine that mess is the rubbish everywhere, all around us choking the world; imagine all chairs, all homes, all safe places you snuggle into… you are snuggling into that disgusting mess!’  Comfort, safety – they felt stripped away.  I felt exposed to a terrifying mass, surrounding me, closing in.

In turn this too changed.  For a long time the images were of a specific food stuff – a gooey, horrible dessert, which, I’m sorry, I’d rather not describe.  But really it doesn’t matter.  As each image changed, what used to upset me no longer did.  I could often deliberately think of previous images and they didn’t bother me, or if they did, the thought passed out of my head.  But the distress remained, and worsened.


22 years old: Conceptual crisis

In 1993 I was in an utter mess.  To this day I have a difficult, anxious, OCD relationship with the number 93.  Some weeks I couldn’t operate at all, and was bedridden, wishing I could just not think at all.  The images had gone after one day the foodstuff image took the place of something else as a punchline in a joke.  My response was devastatingly strange.  My compulsive, defensive instinct was to try to stop the image being associated with the joke, so as not to ‘contaminate’ it.  But then this other thought smashed everything away.  What was funny about the joke anyway?  How does it work?  How does any joke work?  What is humour?  Why is humour?  How is humour?  I scrabbled mentally to explain, and with every explanation opened up a trap door – what did I mean by this?  What did I mean by that?  What is enjoyment?  What is beauty?  Why do you like things?  Explain and justify these things!!

Within a week, all the unpleasant, upsetting mental images had gone.  But they were replaced by this non stop, howling, abstract storm in my head, which carried with it all the feelings of physical discomfort and exposed wrongness that used to accompany the images, and which I knew could not go until I lived up to my responsibility, and solved these unsolvable abstract riddles.  Consciousness was exhausting.  All I wanted was this crap out of head, or just to be dead.

And then help at last

The diagnosis of Obsessive Compulsive Disorder and subsequent psychiatric help late that year saved me (see earlier posts),  and until a little over a year ago, management of my illness has been pretty successful.

But see how varied it can be: an irrational fear of the contamination by chemicals.  Upsetting, stubborn mental imagery.  A compelling need to justify my own thoughts at the cost of despair.  All parts of the same illness, and none of them as funny as arranging my pens by colour.  What is it about these thoughts that makes them so disordered?

Well, the answer is – nothing.  They are, no matter how weird, just thoughts.  It isn’t the content of these thoughts that is the problem in OCD.  It is the mental interpretation of them.  It is in this, and the response, that we find the disorder.  As I shall discuss next time.

Beyond the OCD Myth

There is a myth about OCD, and it is a harmful myth.  This myth forms a common public perception: cleanliness, organisation, order, symmetry, doing things in threes, having quirky rules about how you set out life.  Being the love-child of Monica in Friends and Sheldon in Big Bang Theory basically.  What about this is a myth?  And what is harmful about it?

Well, for a start if it really was all a highly sensitive concern about or distaste of germs, dirt and disorder, involved habitual, unnecessary hand-washing, then I, of anyone, should be a textbook example.  I have very good reason why such things should worry me.

Let me digress for a moment, with a short story about me.

Almost five years ago my life changed, to a certain degree, when I was admitted into London’s Royal Free Hospital with a mystery illness.  I had hepatitis, my spleen was distended, and I was – to paraphrase some of the best medical minds at one of the worlds’ top research hospitals – properly buggered.  To cut a very long story (which is still ongoing) short, I have a very rare autoimmune disease, which at first attacked my joints and liver, but given the opportunity would adopt a scorched earth policy throughout my entire body.  At this stage all I can say about my immune system is: ungrateful little bastard.

I was off work for the whole of 2012.  I take a pretty large amount of medication, most of which is, quite frankly, not very good for me.  I take two sets of medication that suppresses my immune system.  This comes with the obvious risk that I am highly susceptible to infection, and when infection occurs I cannot fight it.  As an extra exciting bonus, my liver is no longer very capable of dealing with infection when it does occur – so I’m left on a bit of a knife edge.  I have been readmitted to hospital a number of times since with infection problems.  My illness is still under investigation, as it is so complex, but what has been made clear to me is that it will not go away – and there are a number of ways in which it is likely to go south at any given moment.  Upon my most recent hospitalisation, this past summer, I enjoyed a bone marrow biopsy, and am currently under the care of three sets of consultants, two at the Royal Free, one at the Macmillan Cancer Centre, University College Hospital.

Now, I’ not looking for sympathy or awards for dealing with this (I will accept amazon vouchers – or just cold hard cash – if you really insist).  While I am pretty annoyed at some of the impact on my social life (no beer, for heaven sake!) I do deal with it pretty well.  It’s serious, but you’ve got to laugh, eh!  I tell this story though so that you know I have good rational cause to be fearful of germs.  The very serious consequences of infection are drummed into me, so I should take measures to avoid it which could very easily become excessive… and yet… I’m really not that bothered.  I don’t worry about it and have to admit sailing pretty close to the wind sometimes regarding precautionary measures.  I don’t wallow in filth or anything, I shower each day, my room is (relatively…mostly) tidy enough… but sometimes it’s a chaotic mess, and I spare it very little thought.  None of it really worries me at all.

So how can that be Baz?  You’ve got OCD man!  You’re supposed to be fussy about germs and cleanliness at the best of times…  Oh, yes, right – that’s the myth!  So where does this myth come from then?

Well, for some people OCD commonly can express as an irrational fear of infection, or an extreme discomfort about certain physical features of their environment.  This overwhelming upset is in response to an invasive, obsessive, thought, trapped in the sufferers mind.  The resultant washing or carrying out of specific behaviours to alleviate this fear or discomfort, and remove the obsessive thought, is a compulsive behavioural response.  Such responses become excessive, as they never can alleviate the fear or discomfort, and actually reinforce it (more about this another time), so have to be done more and more.  And to take washing as an example there is nothing ‘fussy’ about this behaviour.  There is a very real need, a seemingly irresistible urge.  Think of that word: compulsion.  You are compelled, you have to do it.  I recently met someone who prior to hospitalisation was trapped in her shower for 9 hours a day, and suffered a great deal of damage to her skin.  OCD victims becoming housebound prisoners, using bleach on their bodies… these really happen.

But my OCD involves nothing to do with germs, washing etc.  The illness expresses in many, many different forms – impossible to list here.   The invasive, intrusive thoughts can be anything, and the compulsive responses demanded as protective measures, can be anything – either external behaviours, or internal patterns of thought.

A number of things make the myth harmful.  If people believe only the myth, then they are misunderstanding and underestimating a serious mental illness that this year was added to the list of ten most debilitating illnesses by the World Health Organisation.  It is demeaning to, and dismissive of, the anguish and despair that those suffering the illness experience.  Would it be acceptable to be so dismissive and demeaning towards the symptoms of cancer?  No.  Given the seriousness of my physical health condition (while I’ve been flippant about it and am doing ok at the moment, the consultants make very clear how serious it is), I feel that I am qualified in making the comparison.  No matter how serious it is, I feel far more affected by my mental health situation.  If I could be free of one of the two, there’s no hesitation: I would get clear of OCD and take my chances with the physical disease.  Being dismissive about it makes sufferers ashamed and not seek help.  It also means that for all those suffering OCD which in no way resembles or has reference to cleanliness/washing etc., they either don’t know what is wrong with them, or people they turn to for help do not know what is wrong, and they suffer on without help.

Great, now we know what OCD isn’t, what it doesn’t involve.  So, if that is the OCD myth, what is the OCD fact?  What is it all about?  How does it work, and what makes is so bad? Even if I can’t list all the possible ways it expresses, I can at least tell you what has happened to me, right?  First hand insight?  Ah, yes… I’d rather worried it was going to have to come to that.  I guess I has better make a start on relating some of my experiences, next time.