Jon Richardson and OCD

Just some thoughts on Jon Richardson's excellent Channel Four programme on Obsessive Compulsive Disorder this week. Jon did a great job investigating the problem of OCD; coming at it from the perspective of someone living with mild obsessions and compulsions himself. Diagnostic tests towards the end of the documentary suggested his difficulties were not sufficiently severe or distressing to attract a clinical diagnosis of OCD. But his experience of what he called 'quirks' gave him a great deal of empathy for those who did live with the disorder in its severe and debiliating forms.

Jon interviewed three individuals living with the disorder and it was distressing to see the torment these individuals were experiencing. First of all Jon met a young man, aged fifteen, whose life was becoming increasingly populated with obsessions and compulsions, expressing themselves as rituals about where and how he placed his feet and how many times he touched things. He perfectly expressed the bind at the heart of his OCD: 'If I don't perform the rituals then I experience distress that leads to more rituals and more OCD'.

Another person living with OCD was unable to let Jon into her home. Her OCD showed itself as a fear of contamination and to ward off the fear of inhaling dust and being 'permanently contaminated' she cleaned and cleaned. One of her rooms was sealed and dust free. Her partner was on the point of leaving, unable to cope with her relentless pursuit of safety through cleanliness.

A third visit was to a women who lived with OCD, ordering her life to prevent dirt and dust entering her home. When she or her husband entered the house they each showered and changed their clothes. This preserved the inside of the house from contaminants and allowed her some peace of mind. Further tragedy was revealed when she began to tell the story of her son. A truly gifted engineering student so tormented by obsessions and compulsions that he poisoned himself to death by blending twigs and leaves from a Yew tree and drinking the result. It was a sobering thing to see obsessive compulsive disorder on the death certificate. Sad to see the grief as she carefully removed her son's suicide note and other documents from its dust free folder. She regarded OCD as a blight on the family.

There is evidence of OCD being inherited, with early onset at age seven and late onset in the early twenties. Jon talked about his perfectionism, and his mother commented on the delight Jon experienced when book shelves were orderly. Perfectionism certainly seems a character trait associated with OCD. But Jon and the people he visited sometimes linked OCD with stressful, even traumatic experiences.

So it seems some individuals are susceptible to OCD. Risk factors including genetics, personality traits, and environmental factors, such as whether or not other family members have OCD. Then there are triggers - stress and distress. OCD's positive intention is to manage the resulting anxiety, setting in train a self-maintaining system of obsessions and compulsions with the potential to take over an individual's whole life and being.

Jon Richardson's programme left one feeling a bit hopeless. Each visit ended with Jon more aware of how debilitating the disorder can be. The hospital he visited used medication and exposure and response prevention to treat very severe cases with an 80% recovery rate. That was more hopeful; another programme showing how people recover from OCD would be most welcome.

Personifying Obsessive Compulsive Disorder (OCD)

In a recent blog post on Psych Central, Janet Singer wrote about her son Dan and his Obsessive Compulsive Disorder (OCD), which became so severe at one point that he was unable to eat. Distressed and confused Janet turned to a psychologist friend for help. He told her that Dan and his OCD were in a 'battle'. On good days Dan had the resources he needed to win the battle, on bad days the OCD over-powered him. This made a lot of sense to Janet and she began to refer to her son's OCD as 'the enemy'. She says it's a common approach to the treatment of OCD and enables the individual living with the condition to separate himself or herself from the 'disorder'. Janet says OCD is an 'insidious disorder' and that some 'battles' in the 'war' will be won and some lost, the important thing is that 'those suffering from OCD keep fighting'.

Over the years I've worked with many individuals living with obsessions, compulsions, and with OCD. I've been mostly successful in my helping, using a pluralistic approach, creating an individual therapy for each of my clients, using counselling, Cognitive Behavioural Therapy (CBT) and Neuro Linguistic Programming (NLP) .

Sometimes though I am unable to help. Often this is because the client has something else stressful happening in his or her life that constantly activates intense episodes of obsessive-compulsive behaviour. It's incredibly difficult to control OCD when the storm is raging. In those circumstances I offer support and I work with the client to resolve these 'external' sources of stress. If stressful life events happen whilst the client is having counselling then it's likely that he or she will have learnt strategies (1) to deal with this 'incoming' stress and (2) to manage their OCD. This usually prevents the OCD from escalating out of control.

In many ways I agree with everything that Janet Singer has said. One of my aims when working with clients living with OCD is to help them recognise and label OCD thinking; and it can be difficult to identify obsessive thinking when one is in the middle of it, the most irrational of intrusive thoughts can seem real when they are accompanied by intense feelings. But recognising and labelling OCD thinking requires the individual to stand outside of the OCD ; it is, I think, the first step towards mastery. It introduces the possibility of choice - 'This is my OCD wanting me to check the doors and windows of my house. Do I comply or do I not?' The next step may be to learn to tolerate the agony of not complying or not seeking re-assurance. There are many more rounds to go in this boxing match, but at this stage, and possibly for the first time, the OCD is on the ropes!

As you can see, it's very tempting to use a martial metaphor when talking about OCD. I've likened OCD to a boxing match, and Janet Singer uses words such as 'battle' and 'war'. Clients often use this kind of language when describing their experience of OCD and the process of recovery. When this happens I will often follow suit, working to create 'critical distance' between the client and their obsessions and compulsions, for the good reasons Janet Singer identifies in her blog post. I do have a reservation though about labelling OCD as the 'enemy'.

I worry that labelling OCD as the 'enemy' in effect creates a state of perpetual war within the individual, or possibly, periods of peace interrupted by fresh outbreaks of conflict.

These concerns come from my belief in the NLP pre-supposition 'all behaviour has a positive intention' and my training in the 'parts work' of family therapist Virginia Satir. In my view OCD is a 'part' of the individual and it has a positive intention. Like all anxiety disorders it is working incredibly hard at keeping the individual safe from harm. For example, when a person obsessively checks to see if their front door is locked there is a positive intention behind their behaviour, it is to keep his or her property and family safe and secure. In this context OCD isn't the enemy, it's the fire service, police force and National Guard all rolled into one. But of course whilst OCD behaviours might have a positive intention they nonetheless create havoc in the life of the individual living with OCD - this is a 'part' that needs retraining and re-assigning.

So, whilst I do help clients to personify their OCD - and use martial metaphors to 'defeat' the disorder - I may also look to re-assign or re-integrate a 'part' that is out of control by re-directing an individual's obsessive and perfectionist tendencies towards the perfection of a skill or hobby - I sometimes refer to the healthy obsession of the concert pianist. This means that time previously spent 'doing' OCD is spent having some fun and creatively filling the space that OCD used to occupy.

The Pain of OCD

The Dorset Echo provides an insight into the terrible distress of severe OCD

Mr Shaun Nutman, a thirty-three year old family man, was driven to stab himself in the chest because of depression, anxiety and Obsessive Compulsive Disorder. His wife said disturbing thoughts attacked her husband’s mind “like a machine gun”. According to the Dorset Echo, the coronor, Mr Michael Johnston, said he needed evidence that Mr Nutman intended to kill himself to record a verdict of suicide and gave a narrative verdict instead as he believed Mr Nutman was in “such distress from his obsessive compulsive behaviour that he probably really hardly knew what he was doing.” The coronor was critical of the care Mr Nutman received.