Prisoner of the Mind

"Are you sure?"

How often do you hear that phrase? Daily? Every other day? And how often do you have any trouble answering it? Probably not often; after all, you are either "sure" or "unsure" right?

For those of us suffering from Obsessive Compulsive Disorder, the answer is never that simple.

Obsessive Compulsive Disorder, OCD for short, is a disease of the mind that somehow short circuits the natural part of the brain that allows people to be "sure" of something. This could be a moral question ("Did I do the right thing?") or a purely factual one ("Did I turn off the stove before I left today?"). Now these may seem like perfectly normal questions to you, and they are. Everyone deals with these types of questions everyday. The difference for OCD sufferers is that they don't seem to have the ability to be comfortable with a final decision on these matters. They aren't "sure". They need to "check" their behavior in some way. Sometimes this checking takes the form of the well known OCD behavior of "hand washing", which is a response to the question "Did I wash my hands enough?". Or it can take other, more bizarre forms, such as the impulse to continually drive around the block, checking the same spot of street to make sure you didn't unwittingly hit someone with your car. Checking doesn't have to be physical behavior either. Thought processes can exhibit checking behavior too; constantly mulling over the morality of your actions, or worrying that you may have said the wrong thing to your boss are both examples of non-physical checking.

OCD is a terribly frustrating disease in many ways. It attacks people who are otherwise intelligent and logical but for this one enigmatic inability to decide when "enough" is truly "enough". We all wash our hands, yes, but at some point in the process our brains "tell" us that the washing we have done is sufficient. Not so for someone with OCD. Repeating the process will probably provide some comfort eventually, but often not before a tremendous amount of time is unnecessariy wasted by needless uncertainty. Often, a hand washer will rub his/her hands raw before feeling safe, and sometimes not even then.

OCD is often associated with rituals, or what might be termed, "good luck actions" that need to be performed by the sufferer before he or she can feel safe. Hand washing is a ritual, as is repeating the same phrase or song over and over again in one's head, or touching a door in a certain way several times before actually exiting the room. In this way, the sufferer can somehow reduce the omnipresent threat of danger he or she feels about the world by enforcing a type of order on the chaos.

I suffer from OCD and I can say from first hand experience that generalized fear and uncertainty about your ability to confront the daily conflicts and risks that everyone faces is a big part of OCD. I was raised by overprotective parents, who loved me dearly but didn't allow me to face risks enough to feel comfortable with them. Thus, to me, even the smallest risk, that I might have said or even thought the wrong thing, became a huge issue. I was going to go to Hell for things I said or thought; I was worried I would go crazy and do something that would hurt someone I loved. I never did, and now realize that I never would have. But at the time I was a young, frightened little boy who didn't have enough experience with the world to truly be confident with my own ability to cope. So I thought, and I ran phrases and songs through my head to drown out the negative, troubling thoughts. In that day, there was no name for OCD so I had no frame of reference to draw from. I tried to tell my parents what I was feeling, but they were just as mystified as I. I suppose I could have gone to a therapist, but in the absence of any experience with the disease, it may very well have been misdiagnosed and I may have been better not going at all.

It was a problem I dared not reveal to others. Though I did tell my parents, particularly during episodes that became unbearable, I didn't run to them every time I had an "episode" or I would have been going to them every day. It stopped me from doing a lot of things, and hurt my ability to do others. I was afraid to be alone in the dark, I didn't like unfamiliar situations or conflicts I had to face alone. I got nervous or anxious in such situations and did my best to avoid them altogether. I learned to drive as a teenager, but never liked to go out of town, and certainly didn't feel comfortable driving in large cities with multiple lanes.

I covered up my problem with flimsy excuses. I didn't own a car because I didn't need one and it saved me money. I didn't date because I hadn't found anyone I felt that strongly about. I didn't go to a lot of social occasions because I thought they would be boring. In truth, I was afraid of change and doubted my ability to adapt to it.

A year or so after my dad died, I finall reached a point where I felt immobilized by my fears and I sought out counseling. Fortunately, I found a sympathetic, skilled therapist who recognized and correctly diagnosed my malady. She gave me books and articles to read, and set about informing me what OCD was and how to best combat it. I went to her for about eleven months, after which she was reassigned to a different location. At that point, I truly felt we had gone about as far as possible anyway, and was ready to try things on my own anyway.

Armed with this newfound knowledge, I tried to adjust myself to the outside world. I began to drive more, though still not as much as I should have. I took more risks, signed up for jobs at work I would have never signed up for previously. I became more assertive in my dealings with others, and took some more computer classes. I had a long way to go, but at least I was on the right road.

This past March, as anyone who reads these posts knows (uhm, anyone??), my mother died. It's not exaggerating to say this is the most defining (and awful) moment of my life. I had no idea how I would react to this, though as she had been in declining health for a while, I certainly had time to think about it. My fear and assumption was that I would simply cease to be able to function, basically losing the will and desire to live.

I came close.

But, in the end, I decided that whatever life had left for me, I might as well explore it as best I could. It's a cliche, but life truly is a gift, and had I decided to waste it I wouldn't have been honoring the memory or wishes of my mom. What choice did I truly have? It was life...or death. I chose life. But life was never going to be the same in so many ways. My OCD has been kicking in at high gear for a long time; my mom was diagnosed with severe emphysema and lung cancer a year or so before she passed away, and things were very stressful for the remaining period of her life. Her daily care was largely my responsibility, and things at my place of work were likewise very stressful. It was a struggle to get through each day with my sanity somewhat intact.

I am once again seeing a therapist on an irregular basis. He knows about my OCD and is trying to help me confront the issues of my new life. The future is very uncertain, as it is I suppose for everyone. On the downside, my mom, the person I was always closest to in the world, is gone. She 's not coming back, ever. As silly as that last sentence may seem, I can assure you that you might find yourself needing to repeat it if someone important to you dies. I guess losing the most important person in the world is so big you can't ever imagine it really happening. In my case, it was so big I could never imagine myself still being here after she was gone. Sometimes I still can't. It's like half of you is just...gone, and the remaining half spends much of its time searching for the missing half. And that, too, can get to be an obsession.

There are medications that can help people with OCD; I tried one but it really didn't do anything for me, other than give me uncomfortable side effects. The conclusion my therapist reached was that my condition was more than likely not a chemical but behavioral one and that "talk therapy" was probably going to be more useful than medication. I was rather hoping the meds would work; it's always easier to have a "silver bullet" than to have to slog your way through all that personal examination. But, I am what I am, and this is the situation that I have to deal with.

I read somewhere that even after OCD sufferers are diagnosed and treated, it is always hard for them to really trust their decisions because they have gone so long without really confronting risks in a mature, reasoned way they don't have most people's experience with conflict resolution. As a result, their decisions may vary from extremely cautious to extremely reckless. It's hard for them to effectively judge risk. And I find that that's true for me. You want to make your own decisions, but you need to seek out advice on things you aren't familiar with. And once the decision is made, you can't help but mull it over again and again. I've tried and had some success with, just telling myself that no one really has a monopoly on wisdom and that we all make mistakes, and that most of them are instructive and have no terrible consequences. And I try to tell myself that oftentimes indecision is ultimately worse because you end up squandering opportunities for growth.

So, I take my baby steps and I plod my way gently into the world that now seems so big and so cold and uncaring, and I try to get through each day with the knowledge that I am not perfect and that whatever I did or didn't do in the past is done and all that is left is the future. I am unsure of so many things; where I will ultimately live, what my job will be, who will be around me for companionship, what my finances will be, what my health will be like. But I know that I want to keep on living and growing as best as I can. My mom would want me to, and I owe to it myself as well.

THAT I am sure of.