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The Danger of Doubt: The Ruthless and Frequently Misunderstood Logic of OCD

June 27, 2013

Guest blog post by Fletcher Wortmann –
OCD is called the “doubting disorder,” at least among people inclined to give cutesy alliterative nicknames to mental illness.  OCD is the pathological intolerance of risk, however minute, and the surrender to protective ritual, however unbearable.  I know this because I suffered from severe OCD symptoms for twenty years without my family, or teachers, or even therapists correctly identifying my symptoms.  Despite frequent portrayals of OCD in books, television and film, I’ve found many people’s understanding of the disorder is tragically limited.

Now, “intolerance of risk” may not sound atypical or extreme.  After all, each of us has moments when, against probability and common sense, we attempt to eradicate ordinary uncertainty using our minds.

Think about it: You get halfway around the block and realize that you might have forgotten to lock the front door, so you drive back around to check it.  It’s near the end of the seventh inning and things aren’t looking good, so you pull out your favorite baseball cap because sometimes it seems to help.  You call your child’s phone twice to make sure that she got to the party okay.  You cross your fingers, you knock on wood, you wish on a coin or a star or a stray eyelash.

Everyone does this.  It’s not a problem for most people.

But it’s a big problem for people with OCD.

Obsession comes from a simple glitch in cognition. Ordinarily, you have a built-in time clock in your mind. After turning over a certain problem for a while, a committee of highly efficient business-people in your brain decides, “okay, that’s probably the best solution we can come up with for now – enough,” and they table the issue and move on. That’s healthy and normal.

When you obsess, however, your mind refuses to admit defeat, to accept that you just can’t come up with a better answer. After all, what’s the harm in thinking about it just a little more? And more again? When you suffer from OCD, a sliver of doubt always persists that you haven’t examined the issue from every angle; and so you wrestle with your problem a little longer, trying to find a new solution that reduces your uncertainty and leaves you satisfied.

Obsessive-compulsives are taken in, every time, by the promise of one more look at the problem, even if we’ve already worked on it for hours, for days, for months.  OCD demands safety and certainty, and the fact that nothing can ever be totally certain is regrettable but irrelevant to its purposes.

Sometimes this leads to the physical compulsions so many identify with the disorder.  If we have scrupulosity and we’re afraid of God, we may run a rosary until the chain snaps. If we’re obsessed with catching a disease, we may wash our hands over and over again.  Eventually the behavior of the sufferer is entirely divorced from reality.  Hand-washing is no longer a basic hygienic practice but a magic charm, a banishment cast against the ambiguous, malevolent threat of all “germs.”

But these physical compulsions, which so many assume are the greatest burden of OCD, may be only modest indicators of a terrible internal struggle.

And, some of the most distressing forms of OCD have no visible signs, no tangible compulsions. I have a variant of the disorder referred to as “Pure O,” or purely obsessional OCD, characterized by runaway intrusive thoughts. With Pure O, the mind is held captive by its worst nightmares:  fears that the world is about to end, for instance, or that the sufferer is a murderer or a sexual deviant who could succumb to uncontrollable violent urges at any moment.  Whatever the single most inappropriate or offensive thing you can imagine, at any particular moment – Pure O knows what it is, and it exploits it.

With Pure O, these problems can not be put to rest through physical rituals like hand-washing or counting. Instead, the sufferer is left obsessing, silently and almost continuously, incapable of finding conclusive proof that these hideous scenarios will not occur. We can not tell anyone, for fear of being labeled paranoid or psychotic, and because our symptoms are internal, people don’t notice, and we’re rarely offered help.  As an OCD sufferer, I did any number of asinine, irrational things not because they would protect me, but because I thought they might, and I’d be darned if the one night I failed to properly pray the lord my soul to keep was the night I died before I woke.

If a sadistic billionaire decided to gather every Pure O sufferer into an Arkham City of twitching misery, then (according to Lee Baer’s The Imp of the Mind) it would be the fourth-largest metropolis in the United States. Yet the disorder continues to be under-diagnosed. It is the invisibility of the disease that gives it power: because so few can recognize our symptoms and because so many do not understand them, many of us struggle for decades before successful diagnosis.

OCD sufferers aren’t straight-jacketed neurotics or treacherous psychopaths or lovable buffoon detectives. We are people who suffer, in a way that is familiar to almost everyone, but to a degree that no one should have to endure. I lost the first twenty years of my life to OCD but I hope that, by continuing to spread awareness of the nature of the disorder, we can bring it out of the shadows and work to alleviate the suffering of so many.

fletcherCopyright, Fletcher Wortmann, 2013. Author of Triggered:  A Memoir of Obsessive-Compulsive Disorder (St. Martin’s Press), named one of Booklist’s “Top 10 Science & Health Books of 2012”.
http://www.fletcherwortmann.com
http://www.psychologytoday.com/blog/triggered

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