A few weeks ago I took the Yale-Brown Obsessive Compulsive Scale and scored myself as generously as my symptoms might allow. I got a 7 out of 40. A 7 is subclinical, but this wasn’t a true 7: it could’ve easily been a 2 or a 3. In other words, if I walked into a psychologist’s office tomorrow they wouldn’t be able to diagnose me with OCD. Yet I do have OCD – and, what’s more, I’ll have it forever. I’m okay with that. And with Doc Awesome ordering me to “let go right now” I figured I should explain what recovery from OCD actually means – and, more importantly, how I’m going to stay recovered despite having this chronic mental disorder.
Firstly, and most importantly, recovery doesn’t mean the absence of intrusive thoughts. I still get them on a daily basis, although they’re a lot less frequent and a lot less intense than they used to be. They tend to be loudest when I’m travelling. Secondly, it requires accepting that I’ll sometimes have these unwanted thoughts. They’re a symptom of OCD, as unremarkable in that sense as a sneeze is to a cold. I can’t control them; no one can control their thoughts (and if you don’t believe me, try not thinking about pink elephants). No one can control the arrival of feelings or urges, either; both are similarly symptomatic of OCD. Accepting the ongoing presence of these thoughts, feelings and urges is hard. As evidence, look no further than…well, me: I still struggle with acceptance almost six years into treatment. My intrusive thoughts may not be as loud as they once were, but I still get bogged down in their content sometimes, which is a common OCD trap. Content is trash where OCD’s concerned – it’s trash. That’s not me talking, by the way: that’s a direct quote from Dr. Reid Wilson, one of the world’s foremost authorities on anxiety disorders. (I don’t know if there’s such a thing as OCD treatment provider acolytes, but if there is then I’m a Dr. Wilson acolyte: he’s the best.) But recognizing content as trash is easier said than done. OCD preys on your deepest fears, then keeps them running through your mind on an endless loop. I’m impressed by my OCD’s intractability, and as much as I wished it’d bugger off it’s sometimes an oddly endearing adversary, like a pathetic younger sibling who’s desperate for my attention. Sometimes, though, the younger sibling bites.
Hence the importance of acceptance in OCD recovery. For me, things started getting better when I was able to accept, albeit reluctantly, that flare-ups were going to happen, as well as to anticipate when I should expect them. Two weeks ago, for example, I had an OCD spike, but instead of overreacting as I would’ve done in the past I recognized it for what it was (a symptom of OCD and a predictable result of both travel and poor sleep), responded to the intrusive thoughts using cognitive techniques and let the spike float away on its own. I was fine after a couple good nights’ sleep. Another crucial step was learning to ask OCD to keep sending me the unwanted thoughts. It sounds counterintuitive – much about OCD recovery is – but literally every single intrusive thought’s an opportunity to practice my coping skills. Usually I simply ignore the thoughts; if they get a bit sticky I’ll agree with them, either vaguely or aggressively, in a game of mental rope-a-dope in which the odds are somehow stacked in my favour.
This point underscores a critical aspect of recovery: thoughts, feelings and urges can’t be controlled, but your response can be. The goal of Exposure with Response Prevention, or ERP, isn’t disproving the content of your obsessive thoughts, but rather giving them space inside your head – in other words, changing your natural tendency to perform compulsions. The better you’re able to do it, the less the thoughts bother you.
What else can I do to ensure I stay recovered? Glad you asked:
Maintenance work. I’m finished with ERP, but that doesn’t mean I’m finished with ERP…if that makes sense. I still have to confront my obsessive thoughts whenever they happen; I can’t give them an inch or OCD will take a foot. Learning how to respond to the occasional obsessive thought is a crucial skill (here’s a great article on doing just that). Another is doing the opposite of what OCD dictates – like not avoiding people, places or things. If OCD tells me to avoid a certain situation, you can rest assured I’ll go towards it instead.
Exercise. I’m up to three times a week and headed towards six. Being married to a fitness zealot helps.
Diet. I’m creating a new diet that focuses on increasing my energy, strength and mental well-being. Happily, that particular Venn Diagram’s basically a circle.
Medication. I withdrew from antidepressants on June 12, and things are still going well. I need the occasional reminder that antidepressants won’t stop intrusive thoughts from happening, but otherwise I remain cautiously optimistic that I’m done with them forever (standard disclaimers apply). For me, the benefits of withdrawal vastly outweigh the negatives. Take sleep, for instance: I’ve stopped snoring and grinding my teeth, and while I’m still slightly fatigued I’m no longer perpetually exhausted. Hey, speaking of sleep…
Sleep. If there’s a magic bullet, it’s sleep.
I can’t stress this enough: sleep is critical, not just in recovery but to every facet of personal wellness. One of my overarching goals for the coming year is a relatively non-negotiable 8-1/2 to 9 hours of sleep opportunity every night. But that goal encompasses more than simply being in bed by quarter to ten: it includes limiting late nights, curbing my fluid intake during the afternoon (I have one kidney – you do the math!) and establishing a consistent bedtime routine. And again, it’s critical. Obsessive thoughts originate in the amygdala, which is part of the brain’s fight-or-flight system. Did you know that your amygdala’s activity increases by 60% after one night of bad sleep? (I learned this – among many, many, many other things – in Why We Sleep by Matthew Walker, which is a genuinely transformative read.)
Letting go. Doctor’s orders.
So here we are: three months post-withdrawal, nine months since Doc Awesome declared me “recovered” and heading into the great wide open. First stop: Brazil, for which I leave tomorrow. Travel’s usually a good test for my recovery; solo travel’s an even better one. A few months ago this trip might’ve made me a bit nervous. As it stands, I haven’t been this excited for recruitment travel in years.
Scratch that: I haven’t been this excited for life in years. I can’t wait to see where this crazy adventure leads next.