The War Inside
There is no reward for breaking yourself into pieces.
I started writing this article a few weeks ago with mixed feelings on whether I would post it or not. It’s extremely personal and the most vulnerable I’ve been to date. But it’s my authentic story, and my raw cognitive recollection of the life I’ve lived and the challenges I’ve faced. It’s not my intention to garner any pity, envy, sympathy, or empathy from the words that follow. It’s not intended to be a story about being a helpless victim. It’s a reflection about being a human on this earth. And to be honest, these words are written for me more than anyone else. They are a words to the man I know I am capable of becoming, and words I hope he looks back on with pride in making them come to fruition.
For the last eight years, I’ve struggled with obsessive compulsive disorder (OCD). Our society paints the picture that OCD is that quirky mental condition where people like to be neat, tidy, clean, orderly, and need things done in just the right way. It’s common place for someone to say, “Sorry I’m a bit OCD when it comes to …” fill in the blank with some sort of organizational preference that an individual has. But sadly, those statements really sting when individuals who have OCD hear them because it’s not actually OCD.
OCD is defined as when an individual has thoughts or obsessions, and then performs compulsions to alleviate the anxiety or stress that the thought prompted. The key hallmark to OCD is that the obsessions are intrusive, meaning the individual doesn’t want to have them. Performing a compulsion alleviates the anxiety momentarily, but then paradoxically strengthens and reaffirms the original obsession, making the anxiety come back even stronger. OCD is labeled as the 7th most debilitating illness in the world. That’s not just psychiatric illnesses, but all diseases, cancers, and other health maladies combined, and it impacts close to 4% of the population, many of whom are undiagnosed because it flies under the radar. I know first hand, because I went to health professionals for nearly four years before that term ever came up in conversation.
There are close to 15 different categories of OCD. The contamination, symmetry, counting, and checking types are more widely known and what people often associate with OCD. But there is another subset called Primarily Obsessional or Pure-O OCD. Because I wasn’t actively reading medical journal literature on obsessive compulsive disorders, I was oblivious to that diagnosis. But many medical professionals are as well, due to no fault of their own, so this is my small attempt at helping to turn that tide. And if the following experiences resonate with you, just know you’re not alone.
Back in 2017 when the original panic attacks I wrote about previously took place and I started seeing medical professionals to get testing done, everything came back negative or inconclusive. I even had an two hour MRI done on my heart to see if there were any anomalies in the flow of blood from one atrium to the next causing my stress response to activate falsely. I took all the common psychiatric assessments. I saw probably a half dozen different therapists to explain all the trials and tribulations of the past six months that led me to the chair directly across from them.
Each time I explained my story I was told, “Wow that’s a very detailed summary of events and feelings. You are really observant and have great introspection.” I would leave with the ambivalent feelings of being heard but not understood. As much as it was comforting to hear that there was nothing wrong with me from a diagnosis standpoint, it still was frustrating to be living a life that was a constant fight, and not understanding what that fight was.
The nature of my thoughts consequentially caused me to be guarded and apprehensive in opening up to people about my mental struggles. You already feel alone, and because you feel ashamed of your thoughts you close off even further from everyone around you.
On top of that, your thoughts scare you to death, so you convince yourself it’s a burden you have to bear alone because you fear if you told your family and friends what was actually going on in your head it would make them extremely worried. Having others worried about you only amplifies the pressure of ‘holding it together.’
I was so fortunate to be connected with a therapist in 2021 that I felt really comfortable with, and fully opened up with regarding the demons that were in my head. She had a previous client that had similar experiences and thought it would be worth my time to reach out to an OCD specialist. I can’t thank her enough for admitting she couldn’t properly help me, knowing I was really struggling, but did everything in her power to connect me with people who could.
At this point, you’re probably wondering the context to the fight that I’m talking about. What Pure-O OCD is.
Pure-O OCD is a subtype of OCD where compulsions happen mentally instead of physically. People with Pure-O experience distressing intrusive thoughts, images or sensations in their body and engage in hidden compulsions like rumination, mental reviewing, and silent reassurance-seeking to quell the anxieties they experience with those intrusive thoughts. You’re fighting your thoughts with your own thoughts.
“You cannot solve a problem from the same level of consciousness that created it.” Albert Einstein
With Pure-O, the flow of events typically starts with an intrusive thought about some sort of doubt. A “what if” intrusive proposition. “What if I drive my car off the bridge.” For the majority of humans, that is actually a totally normal intrusive thought to have, and if you asked someone if they have ever thought about that before, almost 100% of them would say yes. But as quickly as that thought entered their brain, it flowed down their stream of consciousness never to come back. It was a moment in time that didn’t alter their interactions with the world.
Someone with Pure-O OCD might have that thought, but instead of it passing through their stream of thoughts, it would consistently keep cycling. The original intrusive thought produced a doubt for that individual that made them uncomfortable. Potentially they had the thought, “What if I drive my car into the crowd of people?” and then started creating a story about the consequences of that doubt.
“I would go to jail for manslaughter. Everyone would think I’m a evil person. I would be placed in a mental asylum, never to be allowed in society every again.”
Now because that original intrusive thought has consequences attached to it, an individual with Pure-O OCD begins searching for a way to eliminate that doubt. “How can I be sure I never hit someone with my car?” The internal talk looks like this:
“Why don’t we just avoid streets with a lot of walkers. Next time we have to go into the city let’s just take the metro. Actually, it would be best to never drive a car because you just never know what will happen.”
All the symptoms of OCD follow from an original doubt. Without that doubt, you would remain firmly grounded in reality. Doubts don’t just come out of the blue, there is a trigger for them, and reasoning behind the obsession. And frankly, the reasons your OCD brain comes up with are quite clever, and convincing. Just doesn’t mean that they are correct or valid. You won’t always have an idea on where your reasoning comes from, but when you have Pure- O OCD you feel like you need to act on the doubt in some capacity.
As you begin engaging with the doubt, thinking about consequences, fighting with your own reasoning, you end up creating a narrative story that your brain gets attached to. You create neural pathways in your brain that deviate from logical deduction or reality, and you start living in an obsessional world.
These obsessional ideas start to develop a history and a story attached to them, making them feel real, reconfirming your original doubt. And as you can probably guess, the larger the obsessional story gets, the more solidified your neural circuity gets. Those side road detours your brain originally took start looking like interstate highways for obsessive thoughts and doubts. The obsessions become the default mode for thinking instead of rational, reality based reasoning.
Over time, those obsession become so familiar to you that you think a fundamental part of your core being has changed. The obsessions portray the illusion that you have become the individual your doubts have been fearful of the whole time. You’ve lived in the obsessional world for so long that it now seems synonymous with reality. That is one of the scariest places to be. You second guess every step you take, every move you make, and every thought that enters your conscious state.
You have so many intrusive thoughts that you start wondering if maybe they aren’t intrusive and they are just how you think now. Therapies and practices are in place to identify intrusive thoughts and handle them as so, but if all you have are intrusive thoughts its hard to differentiate an intrusive thought from your normal thinking because your “normal” thinking has been absent for so long you have no substance to compare the intrusive thoughts to.
The war with Pure-O OCD is hard to explain, because again from the outside looking in, nothing seems wrong with you. You’re not in pain, but you’re hurting. You look forward to sleep not because you’re tired but because it gives you the only escape from having to wrestle with your thoughts.
There is a component of anxiety that alters your experience called Thought-Action- Fusion. A brain highjacked by Thought-Action-Fusion anxiety makes it seem that there is little difference between thinking about something and it actually happening. “What ifs” are not experienced as guesses or imagination, they feel like reality. You will have the intrusive thought of pulling a fire alarm. And instead of it being a thought, your body physically experiences the smooth, red plastic clicking through the barrier to activate the alarm, you see your hand on the alarm, and you hear the sirens blasting. You see everyone frantically leaving the building. And you feel the shame associated with being the one who screwed up everyone’s day. It’s all taking place in the obsessional world you created, but again, it feels so real.
Any thought that triggers the alarm makes ordinary risks feel unreasonable. Anxious thinking requires an absolute guarantee that a disastrous experience you think about won’t occur. You feel driven to ask for reassurances of safety and you try to avoid the situations that trigger the feeling. And of course, anxious thinking can’t get that guarantee. You are seeking certainty.
Suffering about unwanted intrusive thoughts is a disorder of over control, not under control.
People can be extremely high performing in spite of OCD, but that doesn’t mean they wouldn’t make a deal with to devil to end the hell they find themselves in. The emotional trauma and suffering that you put yourself through living in the obsessional world of your mind absolutely destroys you.
I know. For better or worse, I mask the pain really well. I can go out in public, live my life, face the fear and no one ever knows. That’s where the article title comes from. Some would say, “Well hey that’s good! That means you’re coping well and it’s not defeating you.” But it also means you’ve chosen to bear the burden alone and aren’t leaning on others for support. It’s a dangerous game.
When it’s bad. Like really bad, I don’t get to turn my thoughts off. It’s an all hands on deck situation. 24/7. Living on the edge of just never knowing when it will end, or if it will end. Therapy helps you build up tools in your arsenal to cope with the intrusive thoughts. But that doesn’t necessarily make it any easier.
If anything sometimes knowing full well what you need to do but feeling like you don’t have the strength to do it makes it all feel even worse. For me it’s also:
“Am I applying my therapy and coping skills correctly or am I doing it wrong?”
“I’ve gone through this experience before so why haven’t I learned from it?”
“Why is it still bugging me even though I’ve coped with it, done therapy, slept 8 hours, exercised? Did everything in my power I know how to do? Why me?”
That is when I have felt the most helpless.
When you know there are areas of your life that you could clean up because you’re not being the best in them right now, you almost have a scapegoat for your issues. If you’ve been staying up late watching television and consequently getting bad sleep, or even something as little as avoiding your PT exercises to rehab your knee, a part of your conscience accepts the guilt of not being your best self. You know you could do more but are choosing an easier, less confrontational route.
When you feel like you’ve locked in and done everything in your control, with the right intentions mind you (reference to previous article), that’s when it gets lonely and the depression start to seep in.
A healthy person has a thousand wishes, a sick person just one.
The best way I can explain the emotional toll that it takes on you would be something like this. Imagine someone was poking you. They continue to poke you for 20 mins. When they are really annoying, maybe for 3-4 hours. You might say, “ok I could put up with that. It would be tedious but I could do it.” Ok, now extrapolate that to 6-8 hours of cumulative poking everyday for 2-3 months. Oh also, the catch here is you don’t get to snap back at them or tell them to stop. You can’t react act all. You have to be completely still. You can’t express your frustration one bit. Your OCD has convinced you that if you do snap (give into an intrusive thought/react to the poking) your life will be ruined because you’ll never trust yourself again. If you give into one intrusive thought, you’ll never have faith in yourself that you could maintain equanimity in the face of adversity ever again, effectively ending your ability to be a functioning human on this earth.
That longing to scratch that itch, to tell that bully to stop, completely drains your emotional reserves. I’m sure everyone knows the feeling of their patience being down to its last straw and the energy it takes to maintain composure.
Exposure and Response Prevention therapy, also known as ERP , is a clinically proven and highly effective tool for gradually getting comfortable with a fear or anxiety that is troubling you. When done correctly, individuals learn to recalibrate their nervous and stress response to the stimuli at hand as to not jump into fight or flight mode. ERP is not easy, and it takes courage to voluntarily put yourself into a position you know elicits stress from your nervous system.
ERP will look different for everyone, but one of the key components to its success is that you slowly build up your tolerance/severity to the exposure. You don’t just ‘rip the band aid off'.’ You start slow and over time acclimate your nervous system to the stressor at hand. Also known as stress inoculation. Another important aspect of ERP, is that you end it. It’s not intended to last forever, as you want to give your nervous system a break from being activated, to allow the body a chance to return to equilibrium.
Say you have a fear of heights. For the first week you might stand 20 feet away from the cliff’s edge. You stay there through the discomfort of the anxiety until you nervous system realizes it’s not actually in danger, or at least isn’t in the danger it originally thought it was in. The next week you move to within 10 feet. The next week 5 feet. Then eventually maybe you even sit on the edge of the cliff. Your body slowly builds up a tolerance to the uncomfortableness of heights. *Note, this is not medical advice or a prescriptive example of how to get over a fear of heights. It is a rudimentary example of how ERP is designed to work.
While ERP has helped me in certain scenarios in recalibrating my relationship with certain intrusive thoughts, it isn’t a blanket solution to all my troubles.
For me, when OCD is bad, life becomes the exposure. There is no off switch. Every room I walk in I scan for threats. My intrusive thoughts start formulating worst case scenarios even if I’m doing a routine task. I’m constantly on edge. There is an ambient feeling that something is going to go wrong at any second, and I’ll likely be the culprit of it. I’m convinced my emotional reserves and willpower will hit empty and I’ll snap.
One of the most difficult pills to swallow during my hardest times is accepting that I don’t have a safe space. Realizing that there is nothing in my power I could possibly do that could end the suffering between my ears. Even if it is for just a moment. If I’m with people, I worry I could hurt them in someway, and when I’m alone I worry there is no one to protect me from myself.
As I said, ERP works when you’re able to walk away and let your mind process the work. When your nervous system is constantly activated because your mind has become a runaway train of intrusive thoughts that are trigger agnostic, and just want to prey on your doubt of being a responsible human being, there’s no walking away from the exposure. The exposure is consciousness.
One example of the pure confusion I can find myself in would be making coffee in the morning. I question how I’m able to pour the kettle at just the right angle and not spill the water over the edge? How do I walk from the kitchen to the couch because my brain keeps telling me it would be so easy to loosen your hand grip and drop it on the floor? What’s keeping me from spilling it on my laptop once I sit down? My brain keeps asking questions I can’t find answers to. Causing anxiety and panic to seep in.
As I learned about the other forms of OCD, I grew so envious of the other various subsets, or even other certain obsessions individuals with Pure-O OCD had. To me, someone who just had an obsession of checking to make sure the door is locked, or that the stove was off, couldn’t possibly say they have it as bad as me. “Just check the door one or two times and walk away.” They don’t have to wrestle with triggers every single moment of the day if they just choose to not put themselves in the environment with the trigger.
It’s once you realize that your OCD story is personal to you, and their OCD story is personal to them, you empathize with the mutual understanding its your corresponding stories that provoke the anxiety you feel. It’s not the trigger itself, or even the obsession that determines the anxiety. It’s the obsessional worlds you have both come to live in and the way in which you’ve been victimized by the various tricks of OCD. That’s where I’ve developed true empathy. And where I’ve grown the most the last few years, is in appreciating that we each have elements of our psyche that present problems to us that others would laugh at. That doesn’t make them invalid. That doesn’t make us weird. It only makes us human.
Everyone is fighting a battle you know nothing about. Be Kind.
I listened to a great podcast a month ago with author Simon Sinek and his guest, a dating coach, Matt Hussey (I’ve linked it at the end). Matt talked about how we humans have a skewed interpretation of self-love. We try to apply a ‘romantic’ love model to the way we treat ourselves, which consequentially always leaves us hurting.
Matt said it all perfectly, (this is slightly paraphrased):
“I didn’t get to go to the buffet of humans to choose who I wanted to be. I didn’t get the chance to be anyone else other than Matt Hussey. Matt Hussy though, is my responsibility. I am the only one to have been assigned, by God, to take care of the human that is Matt Hussey. And it is my job to make Matt Hussey as happy as possible, to keep him out of harms way, to keep him from unnecessary suffering, to keep him away from people that don’t have his best interest in mind. Treat Matt like you would treat other humans.”
Just think, you have spent every second of your entire life with yourself. If familiarity breeds contempt, you should have the most contempt for yourself. It’s easy to hate yourself because you know everything about yourself. You’ve been roommates with that talking consciousness thing for the entirety of your life, and it knows all your dirtiest secrets.
But Matt says to think of a self-love model like that of a parent to a child. They love them because they are theirs, not because of their attributes or looks. This child is mine, and that’s why I love them even with all their imperfections.
This is the body I’ve been given. I can’t choose the psychoanalysis composition of my body beyond a certain point. Saying I wish I was different is like asking to be 6’5’’ vs 5’7”. It’s just how I’m made. That change in perspective on self-love takes away the stigma that your condition is your fault. That you screwed up and are the source behind all your troubles. The particular psyche trait is you responsibility yes, but it’s not necessarily your fault.
To a similar point, C.S. Lewis writes in “Mere Christianity,” how as humans we only see the results from the actions other takes. We don’t know their starting point. They may have been given a “crap hand” of genetics/temperament. But God does not judge him based on his raw material but on what he has done with it What you do with that responsibility of taking care of yourself and the actions you make in spite of the inanimate obstacles that hold you back, shows your true character.
It’s not about holding good cards, but of playing a bad hand well.
There is an old adage, established by buffalos, that says '“The quickest way to endure a storm is to walk through it.” The idea being if the storm is traveling from West to East, and you move East to West, the velocities of each entity should shorten the time spent in the tundra.
My approach to dealing with OCD was rooted in this belief. But not to good effect necessarily. In my head, the quicker I eliminated compulsions, the harder I confronted my exposures, the more discomfort I endured when trying to rewire my brain, the quicker I would get better.
But 8 years later, it’s still with me. The “pick myself up by the boot straps” and combative approach I took to healing didn’t fix the issue. Which got me thinking, that maybe the storm is actually going to be constant, and now I’m just burning myself out in the environment I find myself living in. I don’t have to hate myself for saying “I’m tired”, or “I don’t have it in me today.” I can have self-love. Instead of constantly beating myself up for having intrusive thoughts, or wishing things were different, I choose to accept and make peace with the terms of my contract on earth.
I used to think negatively of myself for using a medication to help combat the troubles of my mind. I fought as best I could to not use them. But ultimately, medication is such a moot point. I was trying to get “social points” for being medication free in a society that is frankly, is probably over prescribed SSRI. As if people would think more highly of me for being a “mental health warrior”, doing it “all natural.” Which is where I finally learned the lesson, that no matter what you ‘achieve,’ there is no reward if you break yourself to pieces doing it.
As I said, OCD preys on doubt. It takes time, but I’ve come to realize that in life, there are no guarantees, except the guarantee that holding back, living in fear from life, is a recipe for anguish.
I’ve found four approaches to coping with the anxiety that OCD brings that can help reframe your relationship to the stress, and keep you living your life. The first was taken from the book “Meditations for Mere Mortals,” where Author Oliver Burkeman writes about embracing your flaw/hindering trait at face value:
“Pick the trait that bothers you most bout yourself or your life and then ask yourself what it feels like to imagine that some version of it might dog you to the end of your days. What if I’ll always have the anxious reactions, clench in the stomach, increased heart rate to minor events that don’t warrant them? My first response is to feel crestfallen, but soon thereafter comes relief. I get to give up on that futile struggle, which means I needn’t wait for it to be won before diving into reality. Maybe I never needed to change in order to justify my existence. Maybe I was always up to the task of building a meaningful life.”
Instead of worrying about the consequences of the “what ifs”, be proud of the fact that your facing the fear and putting yourself out into the world despite being scared.
The next approach, which can be done in tandem with the previous or as a stand alone protocol, is recall moments of triumph in your past where you navigated a tricky, anxious situation. When you had initial trepidations about your ability to handle the task at hand, but navigated through the hurdles and got to the other side. Fortify you own self-confidence by reminding yourself that you have done it before. Why is this time any different?
Thirdly, you can distance yourself from the shear humor of life itself. Chris Williamson says,
“Stop taking things so seriously. No one is getting out of this game alive. In three generations no one will even remember your name. Let that give you liberation to drop your problems and find some joy. Life is inherently ridiculous, so you might as well enjoy the ride.”
Lastly, though it’s uncomfortable at first, begin to accept that should your worst imaginations, fears, and worries come true, you will still be ok. This is by far the hardest of all the tips so far. It’s staring the devil in the eyes and letting your guard down. Peeling the layers of the onion back, and feeling the pain of each failure that could come true. Thankfully, I’ve learned that the anxieties your mind creates and predicts are always much worse than the way reality actually unfolds. And remember, feelings are fleeting. The failure you feel in the moment won’t last forever.
Faith is invaluable here. Knowing that God cares not about our actions, but that our hearts are in the right place. That we have accepted our inherently flawed nature as human beings, and know we have been saved by Jesus. He already carried the weight and paid the price of our failures. Not for us to feel indebted to him, but to set us free.
John 13:7 “You may not know now, but later you will understand”
Resources for More Information
Simon Sinek and Matt Hussey Podcast