Tag: mental illness

Self-Fulfilling Prophecy: The OCD Tyrant!

August 4, 2018

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.

September 18, 2017

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.

Cheers.