“I Like the Way I Am” – and Why That Might be a Problem

“I understand what you’re saying – and I’m not interested.”

Blake is sitting in a chair in the therapist’s office and he’s frustrated and defensive. The therapist has brought up an issue that Blake has long refused to talk about – his Obsessive-Compulsive Disorder. Right now he is insisting that there is no problem. He’s happy with things as they are.

“I like the way I am. I’ve been this way my whole life and it doesn’t get in my way,” Blake says.

And, at the present time, this is true – for the most part. In the past, Blake’s OCD

Image courtesy of nunawwoofy at FreeDigitalPhotos.net

has GREATLY gotten in his way. As a young child, his fear of contamination prevented him from getting work done because the pencils might have been touched by other children. Handball with the other kids was out of the question. A dip in a lake where people might have urinated?  Never. His moral scrupulosity in middle school left me standing at the after school pick up spot for half an hour after all the other parents and children had left. Blake was in the classroom clearing every tiny piece of trash off the floor in response to his teacher’s request that everyone help pick up the room. Despite her repeatedly telling him he had done enough, he would not stop. Of course there was also the religious scrupulosity in high school. He would get stuck in a loop saying prayers over and over, trying to get them perfect, and this frequently made him late to school.

Fast forward to present day. Blake is eighteen, hoping to attend college next year, and working to combat depression. He still does little things that are OCD behavior, but he wants to leave them alone. It’s not a big deal, he says, that he washes his hands immediately if he touches money. So what if he washes his bed sheets because a piece of tissue that brushed up against the dog lands there? It’s not a problem for him if he repeats a prayer a time or two. And he cannot understand why his therapist is raising it as an issue at all right now.

“I don’t mind that I do things this way. Why are you bringing this up now?”

When You Have a History Like Yours…

“Blake,” says the therapist, “you’re right. The things you do now are not a big deal. Here’s the thing: if all you ever did was the things you do now, it would be fine. When you have a history like yours, though, where OCD has taken over your life, it’s downright scary to act like it’s not an issue.”

“I don’t understand. Are you telling me I’m not fixed?”

“It’s not a matter of fixed or not fixed. It’s about staying healthy. People with OCD who do the best after treatment work hard at staying healthy.”

“I understand what you’re saying – and I’m not interested.”

“Instead of rejecting this outright, I’m suggesting you consider the possible benefits to you of doing things to ensure your OCD doesn’t grow,” says the therapist.

“If you guys thought I was so sick, why didn’t you tell me before now?  Has this all been a ploy to get me to do exposures?” Blake is downright angry.

“Blake, nobody is saying you are so sick. It is concerning to your parents and I that you accept your compulsions as they are and that you aren’t willing to entertain doing what it takes to protect yourself. Your attitude puts you at risk for relapse and we all want you to start college in the best way possible.”

I sit uncomfortably in my seat, taking this all in. We have tiptoed around Blake’s remaining compulsions for some time now. Getting him out of bed and functioning seemed a more pressing goal. However, the OCD has been the proverbial elephant in the room, mostly because it has been so under the radar and because Blake has been insistent on not looking at it. The therapist is right, though. In my experience treating OCD, my patients who stay healthiest remember that they have OCD and do maintenance work to keep things that way. The ones who want to pretend that it never happened or that it can be ignored tend to relapse more frequently. My son is in the camp of wanting to pretend it’s not there. He leaves the therapist’s office furious.

“I’m Tired of Being Weak and Scared”

Blake is argumentative and demanding on the walk to the car. He tells me that he realizes coming to therapy was all about trying to get him to deal with his OCD. I explain that this is definitely a part of it, but not the only reason, which I know he knows. I am concerned, I tell him, about his unwillingness to take a look at how it might benefit him to acknowledge his OCD and do maintenance work.

And then the tears come…

“I’ve been weak and scared my whole life,” he says. “I’m tired of being weak and scared. And now I’m crying, which proves how weak I am!”

At this point we can actually have a truly connected talk. My young man is not weak. He may feel scared, but he is actually one of the bravest people I’ve ever met. He has stood up to OCD demons frequently in the past. It was tough and exhausting work. I understand his reluctance to revisit that, which is maybe why it feels better to him to allow some rituals to hang around. At the same time, it is important that he understand what risk he might be putting himself at if he maintains this approach. This, I believe, will be his work in the weeks and months to come.

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Glimmers of Hope on Vacation

The OCD in the Family family is on vacation. We are currently in Florida, in a small town on the Atlantic Ocean. The hubby, Michael, and Blake are in their rooms sleeping off the frenzied pace of the last five days. I walk the coast alone in what is unseasonably cold weather, but my heart is warmed by what I’ve experienced in my younger son on this journey.

Michael, our older son, has always enjoyed travel and is up for new adventures constantly. Blake, however, is a different story. He is usually extremely uncomfortable out of his usual environment. For as long as I can remember, he’s felt overwhelmed by new places, sounds, foods, smells, people, and, well – you name it. Compound this with Obsessive-Compulsive Disorder and, in the last two plus years, major depression, and you have a recipe for a very challenging family vacation experience.  We’ve gone on many a vacation where Blake stayed behind in the hotel room or the car, or only went out with us after substantial begging (usually pleading to go back to the car to wait as soon as we’d allow it).

This Time, It’s Different

This vacation, however, has been different. Blake wasn’t particularly interested in going on this vacation. As usual, he came along because we were going. Then something started to happen that none of us could have predicted; he started to enjoy himself.

I first noticed it when we were at Epcot. If you’ve never been to this Walt Disney World park (as we never had before), it consists of a Future World (East and West) and a World Showcase, which features different countries around the world in street scenes, attractions, and food offerings. After a long, cold day in the park, I began to walk more quickly through some sections of countries in the World Showcase. Blake slowed me down, though.

“I don’t know if I’ll ever make it to all these countries,” Blake said. “I want to see everything I can while we are here.” Then he proceeded to walk down every corridor and alleyway he could find.

The next thing I noticed was that Blake picked out a meal for himself at the Kennedy Space Center. Blake, whose OCD often centers around food choices (or, should I say, problems with the food choices around him), at first said he would forgo eating anything at the Center’s cafeterias. He would wait and eat food he was comfortable with back in the car. The next thing I knew, he had a tray filled with food, and even a dessert of astronaut ice cream. He joined us at the cafeteria table and ate, something he hasn’t done in years.

Last night, he had a long discussion with the hubby about all the places in the world he would like to see. What? Blake wants to see the world? He named off basically every country in the world – the more different from our country, the more he seemed interested.

“What about traveling for leisure?” the hubby asked him.

“The thing is, I’m so uncomfortable traveling, I couldn’t relax.” Blake answered, “I may as well go somewhere I can see things and learn about different cultures.”

Manatees in the Morning

This morning, as Michael, the hubby, and I ate breakfast (Blake was sleeping in), we decided to call off our manatee excursion for the next day. It was too far away, we’d have to leave too early, and it was just too cold for swimming in rivers. Plus, we’d been moving at breakneck speed for several days. It would be nice to have one more leisurely day.

We took it as a given that Blake wouldn’t mind the cancellation. So the hubby went off to call the tour company and I took a breakfast tray in to Blake.

“Dad’s cancelling the manatee tour and swim for tomorrow,” I told Blake. “That way we can take it a little easier.”

Blake’s face contorted into a pained grimace.

“Are you reacting to the manatees?” I asked.

“Yes!”

“Did you really want to swim with them?”

“More than anything,” he said, “but I can wait…if that’s what everyone else wants.”

“Let me see what I can do,” I said, as I bolted out of the room. It just rarely happens that Blake wants to do anything, and I wanted to reward his speaking up. I caught the hubby on the phone talking to the tour operator. I waved wildly for his attention, then told him what had occurred.

“Well, it looks like we’ll be coming after all,” he told the tour operator.

I went to tell Blake that the manatee adventure was on and the glee in his expression told me I’d done the right thing.

I Don’t Know What’s Going On, But I’ll Take It

Blake, wearing a hat that belonged to his grandfather, contemplates the space shuttle rocket.

I told the hubby how excited Blake was about the manatee tour. He and I marveled over the exciting things happening with our son on this vacation. The young man who normally doesn’t want to leave home, who only wants to read about the world instead of live in it, and who regularly says he dislikes himself and much of the world has had a few positive days where he seems to actually want to be here and to experience life.

Afterward, Blake and I perused the library at our lodging. He marveled over the books and wished he had more days here to sit and read. He supposed one thousand hours might do. As we passed through the hubby’s and my room, Blake shared his sentiments with his dad.

“You know, Dad, I’ve changed my mind about leisure vacations. Sometimes it would just be nice to sit and read a good book on vacation for hours on end.”

I Just Wash More Than Other People

We pull into the parking lot and get out of the car. I notice that I’ve parked kind of crooked, so I climb back in, start the car up again, and straighten it out. Blake raises a hand to signal that I’m okay now. I notice the glove. It’s stretched out and missing the tip of the thumb where Blake has pulled a thread and the glove has begun to unravel.

As I climb out of the car and we make our way to the therapist’s office, I notice that both gloves are misshapen. The wrists sit limply against Blake’s skin, like they’ve been tugged at too many times and any elasticity is long gone.  Blake is dressed in a short sleeve t-shirt and cold weather gloves. I think he stands out in this appearance, particularly with his thumb halfway protruding from the shredded threads. I don’t say anything. I know better.

I gave these gloves to Blake a few winters ago. His hands get especially chapped and painful for a few months each year. He slathers them in petroleum jelly at night and pulls the gloves on to keep the goop from getting all over everything else. Today he’s wearing them out of the house; his hands must feel extra painful if he’s wearing the gloves during the daytime.

I Just Wash More Than Other People

As we sit in the therapist’s waiting room, I am certain that The Doc is going to comment on the gloves. Anyone who has ever dealt with OCD treatment knows that embracing uncertainty is paramount, but there are few things I can feel more confidently certain about than the therapist honing in on these gloves. In a few moments, my prediction is confirmed. The Doc steps out into the waiting room and, almost immediately notices Blake’s gloved hands. He steps closer to Blake.

“What’s this?” he asks.

“Oh,” says Blake casually, “my hands get really chapped and sore this time of year.”

“Why is that?” the therapist wonders.

“I don’t know. It’s just the weather.”

“My hands don’t do that.” He holds out his own hands.

Blake removes his gloves and displays them for us. They are red and raw. It’s obvious they are painful.

“Have you been washing a lot?”

“My hands have always gotten like this in the winter.”

“How long has that been going on?” asks The Doc.

“Always,” says Blake.

Indeed, I don’t think Blake can remember a winter where his hands weren’t painful, raw, or bleeding. His hand washing at age six was my first big sign that he had OCD. It was something I’d hoped would go away. Despite education and treatment, it is still here, twelve years later. Blake knows nothing but painful winter hands.

“Maybe you’re washing too much,” suggests the therapist.

“It’s not that,” Blake says. “I just wash more than other people, that’s all, but that’s not why. The weather just does this to my hands.”

“You know,” suggests the therapist, thoughtfully, “you could try an experiment. You could decrease or stop washing and see what happens. Then you’d know if it’s the weather or the washing.”

“I don’t want to. That’s disgusting.”

To Purchase New Gloves or Not

After therapy, as we drive home, I note to Blake that his gloves have seen better days. It’s time to toss this pair out.

“But they’re the only pair I have,” he laments. “Do they really look that bad?”

“Yes, they do.”

Blake reluctantly tosses his gloves in a trash can later that day and sadly wonders what he will do to protect his hands. I ponder whether I should buy him a new pair. My inclination is to purchase them (mind you, we live somewhere where the daytime weather rarely gets below the 50’s Fahrenheit), but I wonder whether I’m accommodating his hand washing behavior if I do. He hasn’t asked for new gloves, nor has he said anything about going to purchase them himself. For now, I’m waiting.

I Don’t Want To, But I Have To

“I really don’t want to be here, but I have to…”

It’s another Thursday afternoon and, as usual, Blake, the hubby, and I are sitting in our therapist’s office. In what’s become a more and more commonplace occurrence, the hubby and I are sitting quietly on the sofa. Blake is in a chair hunched over his knees. The therapist is sitting close to Blake and is locked in conversation with him.

I’m not sure why the hubby and I are in the room sometimes, lately, but Blake wants us in there. The hubby allows his eyes to close; I think that’s how he focuses on the intimate conversation taking place to our left.

The topic, as it has been lately, is depression. Blake is describing the all-too-familiar pattern of following his depressed, dark thoughts down an endless rabbit hole of despair. Our therapist is gently directing Blake toward possibly confronting this pattern. Blake shares his perception of life holding no positive meaning. Suddenly, he seems a little breathless.

“This is really uncomfortable to talk about,” he notes. “I really don’t want to talk about it, but I have to.”

I watch him gather himself and continue. He pauses again, later – and, again, he comments. “I don’t want to, but I have to.”

I take this as a sign of bravery, a sign that Blake recognizes that, in order to gain the upper hand on his depression and his OCD, he has some very uncomfortable work to do. Later, I ask him about it, and he confirms this interpretation to me. Blake understands that he must share how he thinks, even though it is incredibly uncomfortable, so that he can move forward and begin the process of healing.

Honestly, this is remarkable to witness. We, as a family, have been though years of struggle. We’ve watched Blake succumb to OCD thinking, and then to depression. He has battled facing anything that is even the slightest bit uncomfortable. Yet, now, at age 18, there are glimmers of willingness to do the hard work – to fight for a life worth living. I recognize that there will be more struggles and steps backward, and that this will be a process. Yet, this is new and it is something I don’t think I’ve ever seen in my son before. I am so very proud of him.

Showdown and Shooting

Brand new baby box turtles

I found last week a difficult week to post. Blake and I had some serious run-ins, and our community was greatly affected by the massacre in Las Vegas. My attention was on home and community and I’m just now feeling like I can give a bit of attention to my blog.

On the Homefront

Blake continues to attend therapy, yet he is really not completely on board. I heard last week that the hubby and I “smother” him – his term. It’s probably true.

“You and so many others keep trying to help me. It’s like life rings are getting thrown at me from so many directions. I’m overwhelmed. And I almost feel like drowning just to get you to leave me alone!” he told me one evening.

I told him I appreciated knowing that he feels smothered by us.

“I feel like I’ve never done anything on my own. I wish you guys would throw me out so I’d be on the street and prove that I can make it.”

“I get it that you want to prove that you can make it, Blake. It just makes me wonder, does the only way you’ll be able to take charge of your own life and make of it what you want have to involve living on the street? Or can it happen with a roof over your head and food to eat?”

When our therapist heard Blake’s reasoning for continuing to resist getting better, he commented, “I guess you’ve got a lot of evidence to prove that continuing to drown does not get people to back off.”

Then he kicked the hubby and I out of the therapy office and met with Blake alone – which was actually quite nice, oddly enough.

In the Community

While Blake was begging for us to leave him alone, the community came calling. Thirty-six hours after the Las Vegas shooting, a colleague reached out. At least ten members of our community had been shot. Many more had been at the Route 91 festival.

“Can you let me know of any Las Vegas debriefing sessions in {our community}? I have one client who was there…another coming in. You are so connected. I know you may hear of something.”

Up until that point, I’d felt helpless. As a psychologist, I know the effects of an event such as this, but I didn’t know how I could help. Suddenly, I knew. I contacted our local community mental health center, a place I used to work and serve on the board of directors. I asked whether they would be offering any community support events. Two days later, I found myself on a panel discussing ways to cope, how to help our children, what we might expect in the days and weeks ahead.

The next thing I knew, I was publicizing support events to our local mental health community, listening to survivors’ stories, showing up on the local news, and connecting those with the resources to those who needed it. Someone added me to a Facebook group for survivors and helpers. There are nearly 350 people in that group. How did so many of our community members happen to be at this event? It felt like a mission. I became consumed with helping.

…And then I kind of crashed. I don’t know if it was compassion fatigue, but I needed to disengage for a bit from the tension in the house and the craziness in the world.

New Life

Just when I felt at my lowest, nature sent me a gift. I stepped into our backyard just before a meeting and was greeted by two, silver-dollar sized baby box turtles. For a moment, my heart raced with joy. Three months ago, I watched in amazement as my thirty-something-year-old turtle laid a clutch of eggs and buried them in her enclosure. Now, two hatchlings sat in the yard, covered in dirt – a beautiful reminder of how life renews itself. A chance for me to step back and breathe.

When OCD Seizes Religion

There is a lot written about Obsessive-Compulsive Disorder and religion. Heck, some of the earliest recognized forms of OCD were in religious circles: people who were constantly in confession, people who said prayers over and over until they got them just right.  At conferences and workshops I’ve attended on OCD and religion, the guiding principal has been that one must respect a person’s religious values and practices, while helping them to separate out that part which is OCD. What, however, is to be done when being religious is all about OCD in the first place? Let me explain.

Blake became religious about six years ago. Our family certainly identifies with our religion. We celebrate holidays, we do attend some services, and the hubby and I enjoy learning and studying about our religion. However, there are very few who really know us who would describe us as a devoutly religious family. That’s why it was a surprise to many when our son became very religious.

The hubby and I believed Blake’s fast journey to religious observance was OCD driven, with fear being the motivating factor. Blake contended that was not true; he professed that he was doing this out of desire and wanting to learn  more.  Still, he repeated prayers, he stressed about the way he observed, and he was overly punitive to himself when he made a mistake in observance. We consulted with mental health professionals and religious authorities to help separate out what was OCD and what was true observance. I embarked on learning more about my own religion in order to keep up with what my son was doing. We were welcomed by those who were more religiously observant and who graciously accepted Blake into their midst. It was a fascinating journey.

Still, although Blake found some happiness in being religious, I often observed that it seemed like torture. Instead of his finding meaning in his observance, he spent many nights awake, crying in despair because he couldn’t believe enough – couldn’t answer whether the Almighty was actually there, or whether he had completely changed his life in vain. The hubby and I were concerned that Blake’s flight into religion might eventually lead him on a path in the opposite direction.

And then, the confession…

It wasn’t a confession in the sense that people with OCD often confess. I mean, Blake didn’t come to us to clear his conscience or to get reassurance. One tortured night a couple of months ago, as he sat with tears in his eyes, he told us the truth that was in his heart.

“I don’t actually believe,” he told us, and then bravely proceeded to tell his religious mentors, who accepted his comments with various degrees of receptivity. The best response came from the mentor who told him that religion was not supposed to cause him despair and pain, and who reiterated that he will support him no matter what he does.

This week, Blake shared his most insightful revelation yet.

“It’s always been about OCD,” he told us. “It’s what so much of my depression is about. I’ve only practiced because OCD made me afraid not to. I’ve realized over the last several days that I’d rather not go on living this way.”

Of course, I immediately became fearful that this meant Blake was suicidal. So, I asked, and he assured me he was not.

“I just think something is wrong when religion makes you want to contemplate suicide,” he told me. “I like to think there is a G-d and that’s not what religion is supposed to do. I’m just not sure what I’m going to do yet. I just know I can’t keep doing what I have been.”

So what does one do when their entire religious practice, or most of it, has been based on OCD saying, ‘You have to, or something bad might happen?’ How does one proceed? Does one give it all up? Does one change things in increments? Blake is terrified to make any changes at all, and it’s because of that old familiar OCD anxiety. He’s terrified to feel the discomfort that comes from defying one’s OCD – and he’s stuck in this in between place.

“I feel like I went searching for G-d. I knocked on the door to his house, but he wasn’t home. Now, I feel like giving up. He knows where I am and he can come find me,” Blake told us, thinking out loud.

“Maybe you went looking in the wrong places or under the wrong pretense,” I suggested. “I can imagine that G-d wouldn’t have wanted you coming out of fear only. Perhaps it’s time for you to approach things in a new way. Maybe it’s time for you to stand up to your OCD and your fear. Maybe your job is to do the things that make you feel scared and anxious.”

“But it’s too scary,” Blake said. “I’m so nervous.”

“You’ve stood up to OCD fears before, Blake. I know you will again when you are ready.”

So my son sits, for now, in his in between space. He recognizes his OCD, knows he must do something different, but is still too afraid to act. The hubby and I support wherever he must be in this process. I can only imagine the difficulty of being where he is, emotionally. And I can only hope that he finds the courage to move forward soon.

Eating Potato Chips Off the Therapist’s Floor

Image courtesy of khumthong at FreeDigitalPhotos.net

It’s a Thursday afternoon and I’m sitting cross-legged on our therapist’s office floor, carefully picking baked barbecue potato chip crumbs out of the tight weave of the carpet. I absentmindedly pop a larger piece into my mouth, savor the spiciness of it, and continue my task. My hubby is sitting on the ground close by, leaning against the wall and sipping iced tea. He chuckles quietly when the potato chip passes my lips.

This somewhat absurd scene began when the hubby showed up a few minutes late to our therapy session. He’d stopped for a bite to eat across the street. He still had his drink and his unopened potato chips in his hands.

“Do you mind if I eat my potato chips in your office?” he asked our therapist.

“Potato chips leave a lot of crumbs,” I say, automatically. Then I add, looking at our therapist, whose exposure antics are well known to me, “But maybe you wouldn’t mind that.”

“Oh, that’s right,” he says. “Potato chips can be very useful. May I borrow your bag?” he asks the hubby. “Sometimes I do this with them,” he says, and he empties the entire bag onto the office floor.

I burst out laughing and I glance at the hubby, wondering how he’s going to handle this. This is the man who admonishes me for some of the things I touch with my own patients who have contamination fears. He reaches for a large chip on the floor and pops it into his mouth. Blake says nothing, though I’m sure he places his face in his palms at one point.

Our therapist asks if we’ve ever sat on the floor at a party or gathering. Of course we have. Then he asks if we’ve ever gotten off the floor and gotten a snack and eaten it without washing out hands first. We both have. Blake is still silent. Our therapist explains that people without OCD contamination fears sit on floor and touch it and then go on to eat a snack with those same hands that touched the floor. He reasons that it’s not much different than eating potato chips off the floor. Then he shifts his attention and moves in to talk with Blake.

As Blake and the therapist talk, the hubby and I each bend over occasionally to pick up a chip and eat it. Soon, it becomes cumbersome and, being somewhat irrelevant to the conversation happening in the room, one at a time, we each move to sit on the floor. We take turns eating chips, as the pile grows smaller and smaller. What first seemed silly becomes a normal process to us, until I am left with tiny crumbs that I pick out of the carpet to throw away. I imagine to myself that this might be what it is like to participate in an exposure for OCD – feeling somewhat silly or hesitant at first, then feeling fairly normal. I also wonder if Blake has taken note that mom and dad were willing to be uncomfortable, even for a little bit. If he is, he isn’t showing it. For the time being, he has bigger issues to attend to.