Don’t Push the River [& other advice]

Last month I was stressing out intensely over writing my next novel.  We’re talking panic, high stress, extreme anxiety, the whole shebang.  There’s a head game in writing, and I was losing it.  Badly.

I reached out to my undergraduate writing instructor, Judith Hougen.  She was a mentor to me in college, and in many ways, she still is today, even though I don’t get to see her nearly as often as I’d like.  I’ve written about Judy on my blog before: how she is laden with wisdom and creativity, how she loves truth and beauty.

We got coffee, and I shared how stressed I was, then I waited for her wisdom.  She said:

InWater1 by carpeemorteem via deviantART

InWater1 by carpeemorteem
via deviantART

Don’t push the river.

The full proverb is “Don’t push the river; it flows by itself.”

A river is going to go where it wants, carve out the path it chooses.  I’m a fool if I think that I can redirect it– or that I somehow keep it flowing.

It quite fascinated me because one of the things that my cognitive-behavioral therapist said to me (digitally recorded for all time in my ERP exposure recording) was this:

“I want you to close your eyes and imagine you’re standing in a river.  The current is strong, and the waters rush past you, pounding you, beating against your legs, hips, waist.  Eventually your whole body is fatigued; your legs are so tired you can barely stand.  Then you finally turn around and let yourself go with the current.”

His point was plainly and simply that he was offering me relief.

And that’s what Judy was offering too.

Judy said, “If you skip writing one night, you have to trust it’s not all going to leave you.”

Judy said, “Let the writing of this book be its own experience.  Don’t compare it to the last one.”

Judy said, “Respect the mystery of writing.

It was like balm to my anxiety-riddled soul.  I am letting her words minister to my writer’s heart.  And letting my one word for 2014– grace— work its way into the cold and lonely places in me like an adhesive that holds me together.

Theme Hopping

Recently someone emailed me and asked if my OCD was more about worrying about hell than it was about worrying if God was real, and I had to say honestly that after twenty-five years of OCD, there aren’t a lot of themes I haven’t experienced.  Is God real, is Jesus real, is heaven real, is Christianity legitimate, was Jesus really God’s son or was he the devil in disguise, have I committed the unpardonable sin?  OCD can cycle through a lot of themes in a quarter of a century.

That’s the thing with OCD: it often doesn’t remain in one place.  When I was still in high school– and even into my college years– I kept thinking, “If I could just sort out X, then I would be happy.”  So I’d wrestle with X, read books about it, seek reassurance, talk things over with my youth pastor and parents, research things online … and if I was ever able to “solve” it, then … my OCD moved onto Y.

Hitman: Contracts by TheKingArthur at deviantArt

Hitman: Contracts by TheKingArthur at deviantArt

I was in perpetual motion for so many years– but I never got anywhere.  It was all spinning my wheels.

Exposure and response prevention ignores the emergencies that OCD is sparking in every corner and goes after the OCD itself.  Instead of relying on compulsions, which temporarily help to “solve” individual issues, ERP is like a hitman with a mission to assassinate the OCD.

You can see why one is far more preferable than the other.

 

The Long Journey … to the Starting Line

"Cross That Line" by xLadyDaisyx on deviantArt

“Cross That Line” by xLadyDaisyx on deviantArt

It is SO HARD for OCD sufferers to be correctly diagnosed and then find the right treatment and a good cognitive-behavioral therapist.  In fact, it takes an average of 14-17 years for someone to access effective treatment.

That stat stings my heart.  I feel it deeply because of my own personal struggle.

I developed a sudden onset of OCD at the age of 7.  I wasn’t diagnosed with OCD until I was 22.  I started ERP (exposure and response prevention) therapy at 27.  That’s twenty years, folks– fifteen just till diagnosis alone.

Growing up, I just assumed that I “thought too much”– was an “overthinker” and especially sensitive to issues of morality. I didn’t understand that other people were also undergoing the same doubts as I was but were able to move past them with ease.  I, on the other hand, would get trapped.  The exit door to my brain was stuck shut, so all my thoughts just milled and churned and generated intense anxiety.  I didn’t know that others even had the same thoughts as I did, nor did I realize how it would be possible to let such thoughts come and go.

In childhood, I cried all the time.  In fact, I cried every single night for three years in a row.  I never told my parents about this.  I was so scared that they wouldn’t be able to “fix” me that I preferred to just rest in my own sadness, still clinging to the hope that *someday* I could be fixed.  As long as no one told me it was impossible, it still felt possible, and even thought I was terrifically sad, I kept that hope as my lifeline.

High school was a beast.  I got straight A’s (OCD drove me to perfectionism) and graduated at the top of my class.  I was a class clown, and I had some amazing friends.  But I battled intense spiritual doubts and lived in great fear.  My tenth grade year was one of the hardest of my whole life.  Only those closest to me knew it.

My doubts intensified in college.  They escalated to a whole new level.  Thankfully, I had a solid support system in my new friends (people who remain my support system to this day!).  And though they couldn’t understand what I was going through, they loved me.

After undergrad, things fell apart.  In a nutshell, I lost my grip on reality– my doubts had grown so large and out of control that I no longer knew if I could trust my friends or my own human experience.  Finally, for the first time in my lifesomeone used the words mental illness with me.  It felt shocking.

I was encouraged to meet with a therapist (unfortunately, a talk therapist– not effective for OCD), who also got me in to meet with a psychiatrist, and I was finally diagnosed with obsessive-compulsive disorder.  A diagnosis fifteen years in the making.

I spent about a year with that first talk therapist, and it was more damaging than anything else.  I finally “escaped” and never again set foot in that clinic.  Meanwhile, I was an SSRI lab rat, trying out a slew of various medications to treat my OCD.  I eventually went back to talk therapy– this time to a much better therapist, who was a true blessing, although she still didn’t truly understand OCD, and so my therapy included a lot of reassurances.  In other words, this kind, amazing woman who loved me was just reinforcing my compulsions.  Not good.  I also took a break from trying out medications after one stole all my energy and made me rapidly gain weight.  I was overweight for the first time in my life– all due to a medication– and have struggled with my weight ever since.

Five years after that initial diagnosis, my psychiatrist was out of ideas.  Literally.  She asked me what I thought we should do next.  I, of course, had no clue.  She referred me to an OCD specialist.

This incredible man– Dr. Suck Won Kim– changed my life.  He got me onto the right medication (almost immediately) and essentially required that I begin ERP, even giving me the name and contact information for the therapist who would ultimately allow me to bottle up my OCD and put a stopper in it.  Dr. Chris Donahue, to whom I’m forever indebted.

Twelve weeks was all it took.  In one sense.  In another, it took twenty years.

My life was a mix of depression, anxiety, compulsions, “bad” thoughts, and wrongness, and then twelve weeks later, I felt the burden of OCD lift from my shoulders.  I was giddy with freedom.  Five years later, I still am.

I hear from OCD sufferers every week who are in their 50’s, 60’s, or even older, who are still seeking appropriate treatment.  This absolutely breaks my heart.

On the flip side, I’ve had the incredible experience of meeting Maddie, 11, and her incredible parents, who leapt into action almost immediately and got her into ERP within months of her OCD onset.  In the same year, she developed OCD, was diagnosed, and was treated.  Marvelous!

That’s one of the reasons I blog about OCD.  To help people to understand earlier what they are dealing with and to encourage them to seek appropriate treatment (ERP, with or without medication).  It still just boggles my mind that in 2013, mental health practitioners still don’t know that ERP is the answer.  People get passed around from talk therapist to talk therapist, when the solution should be so ready, so available.

The Dreadful O of OCD

My friend Janet over at OCDtalk recently blogged about how, so often, all people know of obsessive-compulsive disorder are the visible compulsions, as opposed to the invisible obsessions.  And back in November, The Atlantic also posted about the debilitating nature of obsessions.

As I’ve said before, “If it doesn’t hurt, it’s not OCD.”

OCD begins with obsessions.  Compulsions are actually just a monstrous side effect of OCD.

Source: deviantART "Torture" by eWKn

Source: deviantART
“Torture” by eWKn

Compulsive hand-washing is hard to hide.  Hoarding, definitely.  Even repetitive reassurance-seeking and confession (compulsions of choice for a Pure-O) are easy to notice once someone points it out to you.

But it’s harder to see the obsessions that are driving them.

Imagine the deep horror of constantly imagining you’ll hurt someone you love.  Or the intense mind-screw of questioning a part of your identity that you’ve always gripped tightly.  Or feeling as guilty as a rapist, a pedophile, or a murderer … when you haven’t even left your room.  You know that wrong feeling that you sometimes get to which you can never find the words to describe it except for that it’s just wrong?  How’d you like to feel that every waking moment?  Obsessions come hand-in-hand with such intense anxiety, horror, and guilt that obsessive-compulsives feel they cannot bear them.  Hence, so many compulsions.  And, devastatingly, suicides.

That, my friends, is why I get upset when people say things like, “I’m a little OCD; my handwriting has to be perfect” or “If my socks don’t match, it bugs me so bad.  I think I’ve got a touch of OCD.”  It feels like someone is comparing their hangnail to your amputation.  Does that make sense?

So many people in the OCD community have not yet found their voice, and that prompts me to be even louder.  I know no one likes the person who is so easily offended.  Heck, those people generally annoy me too!  But I’m reacting on behalf of a broken, abused, tortured community who– this is heartbreaking– believes themselves worthy of only brokenness, abuse, and torture.

So I choose to be loud about it.

Thanks for understanding– or trying to.

Guest Post: OCD & Nutrition by David Novak

I screen all guest post proposals, selecting only those that I think will be of high value for my readers.  When Healthline contacted me with this article by David Novak, I was totally won over.  I think you guys– especially those of you with hesitations about medications– will be very intrigued by what he has to say below.  Always make sure to run ideas by your doctor before implementing them!

OCD and Nutrition by David Novak 

ocd and nutrition picOCD or obsessive-compulsive disorder is a type of anxiety disorder, which affects 2.3% of the American population between the ages of 18 and 54. This condition is characterized by irrational or unwanted thoughts, obsessions, urge for repetitive rituals and compulsions. Symptoms usually start during early childhood or adolescence and the exact cause is still unknown. Theories to this condition suggest that OCD manifests due to personality defects and bad parenting, but this is not widely accepted.

OCD impacts the communication systems in the brain and according to the National Alliance of Mental Illness, it produces a chemical imbalance in the brain where low levels of serotonin have been recorded. Serotonin plays a crucial role in mood regulation, learning, calmness and sleep. Several medications can help in behavioral therapy for OCD, since it is known to be incurable. Selective serotonin reuptake inhibitors, or SSRIs, help in raising serotonin levels in the brain leading to reduced OCD symptoms.

Nutritional Therapy

Nutritious diet may not prevent an onset of OCD, but it can assist in managing the symptoms with the help of medications, supplements and mental health therapy.  Here are some nutrition sources documented as effective for reducing the symptoms:

  •  Tryptophan – This amino acid promotes the formation of serotonin, which is essential in mood regulation. It has been shown to be successful in treating OCD, and it’s also effective for other anxiety disorders. Tryptophan is formed from precursor coenzymes found in B-vitamins.  Example of foods with high tryptophan level include elk meat, goat, seaweed, soy, spinach, crabs, halibut and shrimps.
  • Inositol – Inositol is a nutrient related to vitamin B complex, which is needed for the cell membranes’ proper formation. It has an ability to affect nerve transmission as well as transporting fats within the body. Inositol also plays an important role in reproduction and prevention of neural tube defects. It can be found in certain foods such as oranges, cantaloupe, beans and whole wheat grain.
  • L-theanine – L-theanine is known to have a calming effect, which is found to be effective in subduing OCD behavior. It also helps in stimulating alpha brainwave production that promotes deep relaxation. IL-theanine also has properties that can protect against environmental neurotoxins. This amino acid can be found in green tea, black tea and boy bolete mushroom.
  • St John’s wort – This herb has been widely used in treating depression and other psychological disorders. It also has hypericum, which is a chemical that has been found effective in modulating serotonin levels.

Supplements

Natural supplements have a distinct advantage over drugs and medications. They provide larger amounts of raw materials to the brain for the development of serotonin. However, they may become ineffective if the person has deficiency in one or more critical nutrients needed in producing serotonin. It is best to consult your doctor on how you can address and relieve OCD symptoms, and whether these supplements are right for you.  Here are some well-known supplements that have helped many OCD patients:

  •  N-acetylcysteine – N-acetylcysteine is a nutritional supplement used in treating compulsive disorders such as OCD. It has been found to be very effective in hard-to-treat disorders like hair-pulling (trichotillomania).
  • Flax seed oil – Several studies show that taking flaxseed oil can help manage OCD behavior. It is rich in essential fatty acids, which enrich the brain cells’ communication and development.
  • Vitamin B complex – These B vitamins have been found helpful for those suffering panic disorders, depression and OCD. Vitamin B1 plays an important role in controlling blood sugar, which has a major impact on anxiety. Vitamin B3 is involved in several enzymatic processes, especially in serotonin synthesis. Vitamin B5 is also important for the adrenals when it comes to modulating stress. Vitamin B12 and folic acid support against heart stress, especially if you’re suffering from anxiety and depression.
  • Spirulina – This dietary supplement is known to have RNA. which has been found advantageous for the nervous system. It helps in nourishing myelin sheaths and nerves, which are helpful in reducing OCD symptoms.
  • Magnesium – Magnesium is a calming mineral that helps in minimizing the release of stress hormones in the body. There is still limited scientific evidence of magnesium’s effectiveness, but several research shows that herbal supplements containing magnesium may be effective in relieving stress and depression.
  • Lactium – Lactium is a supplement derived from the casein protein in milk. It assists in reducing stress-related symptoms, including anxiety and panic attacks.

David Novak picDavid Novak is a syndicated columnist, appearing in newspapers, magazines, radio and TV.  His byline has appeared in the Wall Street Journal, USA Today, Readers Digest and GQ. David is a specialist at health, wellness, exercise and diet, and he is a regular contributing editor for Healthline. For more information, visit http://www.healthline.com/.

Better than a Bandaid

“Healing” cancer with a Bandaid is the same as “healing” OCD with compulsions.  In short, you’re not healing ANYTHING.

In other words, all those things that obsessive-compulsives do to alleviate the tremendous anxiety they feel?  Not helpful.  Asking for reassurance, obsessive confessing, reciting prayers and phrases, repeating rituals that make you feel “okay” or “balanced,” washing your hands, etc.– they are just Bandaids plastered right over the cancer of OCD.

To effectively go for the “root” of OCD, you have to resist those compulsions.  Exposure and Response Prevention (ERP) therapy is recognized as THE best treatment for OCD.bandaid

Skip the talk therapy.
Skip the (many) reassurances.
Skip the rituals.
Skip the confessions.

Go for the jugular with ERP.

Related posts:
A Detailed Post about ERP
Preparing for ERP Therapy
ERP & Imaginal Exposures

How I Fall Asleep

can'tsleep3Obsessive-compulsive disorder.  If you can put two and two together, you probably realize that falling asleep is difficult for many of us with OCD.  Our minds won’t stop processing.  Sometimes I’d imagine that my roomie could hear my head from the next room over, churning like a coffee grinder as I rehashed the day, worried about tomorrow, and let my mind chase its own tail as I ruminated on unknowable concerns.

The same thing unfortunately happened on long car rides.

My solution for both was simple, though there’s no guarantee it will work for others.

Audiobooks.

Instead of trying to turn off my mind, I instead gave it something specific to think about, to dwell on, to follow: a story.

And not just any story, but a story I was already familiar with.  This was important because then I could fall asleep without worrying that I’d miss something.

I also take risperidone (can’t sleep without it!) and melatonin (to help me stay asleep through the night).

Anyone else have any clever ideas for falling asleep with OCD?

Related posts:
When Thinking Hurts
Amazing Audiobooks

It could be the smiling person next to you.

depressed

Only my closest friends and family ever really knew what I was dealing with.  I smiled a lot, was the class clown, told great stories, graduated summa cum laude.  No one would have looked at me and guessed that I was drowning in depression, a slave to OCD, driven to certainty in unhealthy ways.

Try to hear what people aren’t saying.  And have more discussions.

Related posts:
My Darkest, Lowest Days
The Sons of Korah Get It

OCD: Unwelcome but not Unexpected

How many times do I have to say that OCD is a joy-thief before I should realize: Oh.  Hmm.  You’re pretty happy right now.  OCD will be along shortly to steal that away?

I should learn to brace myself.

On Friday, November 22, I announced on Facebook and on my blog that Harper Collins offered me a two-book deal.  Shortly thereafter, amidst all the “likes” and congratulatory comments and joyful sharing, OCD came calling.

I spent the majority of the evening obsessing over future revisions.  

not you again

I practiced ERP, walking myself through that lovely mantra of “it’s POSSIBLE, but it’s not LIKELY,” then discussing with a friend (asking for no reassurance), and also spending time in prayer.

Life, as I continue to learn, is risky, and the more I learn to embrace risk and uncertainty, the happier I am.

Which is why I flat-out refuse to flat-out refuse any revision suggestions.  I will consider everything my wonderful editor suggests, knowing that God is in control and that Jill loves my characters too.

In this sense, I’m growing as an obsessive-compulsive in remission, an author, and as a person.

Jackie 1
OCD 0

Related posts:
Uncertainty is the Key
Uncertainty
Taking Risks

An Uncertain Framework

I used to get thrown by anything I couldn’t know FOR SURE.

Is real life real life, or am I just dreaming?

Am I going to heaven?

Are my friends really my friends?

What do people really think of me?

Are people even really people?

I mean, completely thrown.  I had no framework for dealing with uncertainty.  And the truth is that a person just cannot live that way.  It’s not how life works.

Now that ERP has re-wired my mind, I am finally able to say, “I’m just going to have to accept that I can’t know” and carry on with life.  I never thought I’d be able to approach such huge things with that kind of statement.  Never. If you’re reading this and think that that is an impossibility for you, please know that I once thought the same.

uncertain

Related posts:
Narnia and Uncertainty
Uncertainty is the Key
Uncertainty
Interview with a Former HOCD Sufferer
No Antidote
Life is Risky Business