Friday, February 27, 2015

A Doctor of Education Shares His Personal Experience with OCD Part 2

WEIGHT OF THE WORLD ON MY SHOULDERS


As I struggled with OCD, I eventually fell prey to all ten of Dr. David Burns’ cognitive distortions. The amalgam of these distortions gave me unrealistic expectations for perfection, and resulted in the enormous pressure of maintaining a spot-free conscience at all times. Generally speaking, we can all benefit from striving to live with a clear conscience. The problem with my OCD was that my cognitive distortions created sins that were not really sins at all. These distortions not only created unrealistic expectations regarding my own behavior, but they also induced a sense of unnecessary responsibility for others that was often presumptuous. This resulted in getting me entangled inappropriately in other people’s business.

The sum result of this madness was a self-imposed punishment that saw me morph into a mentally ill Atlas archetype, burdened by the self-imposed responsibility for perfection not only in my own conduct, but also for the moral actions of other people—and not just one or two persons, but essentially the entire Planet, or at least anyone with which I came into contact. It was an utterly infeasible task, and placed an indescribably heavy burden upon my shoulders. This obsessive sense of faux responsibility traveled with me everywhere I went, and obnoxiously stuck its head into virtually every situation in which I found myself.

It also conjured up many situations and circumstances that did not exist except for in my own troubled mind. As a result, I often had a sense of panicked-urgency to take action when none was required – action that often led to more harm than good. In the process, I annoyed—and probably bewildered—many a family member, friend, acquaintance, and even stranger. To this day, I still shudder when I recall some of the ridiculous things I did because of my neurotic moral responsibility. Moreover, such an anxious and discontented spirit made it difficult to develop normal, functioning, and mutually satisfying friendships or relationships with my peers.

Amazingly, I held myself hostage to these self-imposed and unrealistically high standards for an ungodly number of years. How I avoided a nervous breakdown is a wonder to me. The sense that I was teetering on the edge of insanity at times prevailed for many years, and created a tremendous sense of existential insecurity and vulnerability. Fortunately, I was always able to somehow hold my ground, but there were times when insanity might have proved a welcome reprieve from the ever-conscious conundrum of my agitated neurosis.

It was not until I began seriously attending therapy after my mission that I finally started to relinquish this unrelenting burden. Even then, my achievement of mental hygiene was accomplished incrementally over a long period. In the ensuing years, and through much cognitive-behavioral treatment (professional, homespun, and self-help) I have become better at recognizing the difference between real and imagined responsibilities.

As I continue my journey through life, my mantra has become to simplify anywhere and everywhere I can. The process of simplification and the accompanying re-organization takes time. It took me seven years to achieve a satisfactory level of simplification, and the journey has by no means ended. As time passes, I get a little bit better. It’s taken a long time and a lot of effort to shrink my perceived responsibilities down to their actual size, but it has been well worth the effort. With help from God and my support network, this effort has initiated enormous healing, and allowed me to be happy and at peace.

SOCIAL DIFFIDENCE AND UNEASE


In elementary school, I was charismatic, cheerful, and extroverted. I had many friends, was popular with my peers, and was well liked by my teachers. In first grade, I was voted class president. In third, fourth, and fifth grade, I was voted by my classmates to represent them in the student council. In fifth grade, I was cast as the lead male role in the school play. A talented and respected athlete among my peers, I was routinely one of the first players picked when selecting teams to play basketball or football on the playground. I was well liked by both my male peers and my female counterparts. In fifth grade, I even had three different girls vying for my affection. One girl in particular I especially liked, and turned down her invitation to “go out” only because my church taught me not to date until age 16. Inspired by my older brothers’ obedient examples, it was important to me to follow in their footsteps by living true to this tenet of my faith.

This youthful popularity and social success came to a dramatic halt in seventh grade following my graduation from elementary school. The onset of my mental disorder was exacerbated by the external challenges and realities of being thrust out of a relatively innocent elementary school world and into a junior high environment that, by comparison, seemed like a cesspool of puerile prurience. It took me nearly two decades to recover completely from the social repercussions of OCD that began taking root in seventh grade. My high school and college years were particularly negatively affected, especially as it related to romance.

DEPRESSION JOINS THE MIX


Over the years, I developed comorbid depression. For every ten days I’ve spent under the yoke of OCD, five or six of them have been further tainted by depression. Depression has also morphed into its own unique manifestation of obsessive thinking. This has been one of the most nefarious influences in my life, as it seeks to stamp out joy wherever it attempts to blossom.

My obsessive depression has made it difficult to experience and enjoy those blessed moments of spontaneous joy that crop up in life from time-to-time. This joy-killing process plays out like this: I feel joy for a few short seconds and then, almost as soon as the joyful feelings or thought has passed, it is immediately sabotaged by awful feelings of despair, self-loathing, and a barrage of other painful obsessions. It is as if my condition condescendingly screams at me to say:

“Listen here dumb ass! Don’t you know joy is unacceptable around here? Here’s something really unpleasant to think about; now ruminate on it till all your damn joy is smothered. Oh, and by the way, I hate you and wish nothing more than for you to experience continuous misery every day of your life. Blank you, you blanking piece of blank!”

This permutation of obsessive depression has been omnipresent throughout all other obsessions I’ve experienced. Indeed, it seems to be the very essence of my OCD itself. It is a fiendish monster eternally committed to the corruption and annihilation of as much peace, happiness, and joy as possible.

PHILOSOPHICAL & EXISTENTIAL OCD


As an adult, most strains of OCD I suffered with in high school and college have either diminished significantly or virtually vanished. Nonetheless, for the past decade or so, perhaps the most perplexing strain of all has replaced other strains to produce tremendous anxiety and obsessions surrounding unanswerable existential questions about life and eternity. While I am a person of faith, religion and faith do not answer all questions, and my OCD-inflicted brain is quite adept at finding unanswerable queries to dwell on. Fred Penzel, Ph.D., an OCD expert, recently wrote about this “flavor” [1] of OCD in a recent issue of the International OCD Foundation’s “OCD Newsletter.” [2]

Many people in the general public and the media have a very stereotypical image of what OCD is all about. Individuals with OCD are seen as people who either wash their hands too frequently, or who are super organized and perfectionists. Thus, it can be difficult to recognize the types of OCD that don’t resemble these common stereotypes. The reality is, there are many forms that OCD can take. The types and topics of your obsessions and compulsions are limited only by your brain’s ability to imagine. OCD is insidious, as it seems to have a way of finding out what will bother someone the most.

In concert with the mental malaise and general depression produced by this existential strain of OCD, I also experience panic attacks where I feel existentially trapped, imprisoned, and psychologically strained to a near breaking point. These panic attacks are accompanied by a frenzied sense of nihilistic dread that sweeps over me like a cold, wet blanket. These attacks make me wish I could escape from my body and mind, both of which seem like shackles and instruments of torture. The only certain escape from such moments is to completely immerse myself in an activity that places a substantial cognitive load on my brain, thus successfully distracting me from the obsessions. There are several activities that provide this complete mental immersion (e.g., writing, speaking, engaging conversation, eating a delicious meal, watching an interesting movie or documentary, downhill mountain biking, detailed yard work, playing video games, and sex with my wife). I am deeply grateful for God that such activities exist as a healthy reprieve from such ponderous burdens.

As described in the sonnet below, these panic attacks give me great grief. They cause a deep dislike and fear of life, and instill a desire for death, non-existence, or at least a divine reprieve from the suffering. Such moments also provide a vivid appreciation of, and empathy for, the madness that drives some to suicide.

Sonnet 21 [3]: The Passage of Time

Thanks be to God for the passage of time,
That life marches on to a welcomed grave,
Where at last we may hasten the sublime
Status of being, in a new enclave
Outside of time—that fleeting enemy—
Which serveth death to each blessed moment
We would fain prolong through eternity.
When after all each precious second sent
Away, lost, returns with divine interest
Into the holy coffers of the soul,
Wherein we may perpetually invest
In glory that ne’er dies, which doth cajole
A sharpened focus of my use of time;
That I, by spades, might yet summit the climb.

In one of his poetic masterpieces, the late British poet (Wordsworth) once lamented the woeful state of the world when he exclaimed in his immortal sonnet:

William Wordsworth
The world is too much with us; late and soon,
Getting and spending, we lay waste our powers.
Little we see in Nature that is ours;
We have given our hearts away, a sordid boon!
The sea that bares her bosom to the moon,
The winds that will be howling at all hours,
And are upgathered now like sleeping flowers—
For this, for everything, we are out of tune;
It moves us not. Great God! I’d rather be
A Pagan suckled in a creed outworn,
So might I, standing on this pleasant lea,
Have glimpses that would make me less forlorn,
Have sight of Proteus rising from the sea,
Or hear old Triton blow his wreathed horn. [4]

My obsessive ruminations about the otherworldly and the endlessness of existence cause me to wish I could be more present in the ‘here and now,’ as others seem to do so effectively. Such drowning in existential anxiety profoundly inhibits my ability to be an emotional participant in my own life, causing me to miss out on many smaller moments of happiness others might routinely experience. Such experiences influenced my penning of the following sonnet:

Sonnet 17 [5]

The world is not enough with me, NOW,
Too much time spent thinking and forecasting,
Trying too hard to see it all—blasting
The feelings and peace—I fail to allow
Real emotions, the wonder, the WOW,
The satisfied sense of sweat on my brow,
And pure joy—spontaneous in my youth—
The unsullied acquisition of truth,
It moves me not! Great God, I’d rather be
A zealot, willing to fight and to die
For any just cause that might make me free,
Possessing the will to work and to try,
What e’er it may take through eternity
To gain the God-granted privilege to fly.

SEEKING HELP


M. Scott Peck, M.D. suggests that rather than classifying the human race into a simplistic dichotomy of the mentally healthy and the mentally ill, it is more accurate to view mankind as existing along a spectrum of mental health.

[The] tendency to avoid problems and the emotional suffering inherent in them is the primary basis of all human mental illness. Since most of us have this tendency to a greater or lesser degree, most of us are … lacking complete mental health. Some of us will go to quite extraordinary lengths to avoid our problems and the suffering they cause, proceeding far afield from all that is clearly good and sensible in order to try to find an easy way out, building the most elaborate fantasies in which to live, sometimes to the total exclusion of reality. In the succinctly elegant words of Carl Jung, “Neurosis is always a substitute for legitimate suffering.” [6]

According to Peck, “All psychological disorders are basically disorders of consciousness.” This paradigm breaks with Freudian concepts that mental illness is rooted in the unconscious. Peck’s paradigm that neurosis is rooted in consciousness grants more choice and control to the patient, but it likewise creates personal accountability since neurosis is ultimately a result of “a conscious mind that refuses to think and is unwilling to deal with certain issues, bear certain feelings, or tolerate certain pain.” [7] According to Peck, “therapy’s purpose is to help people become more aware so that they can think more clearly and live their lives more effectively and efficiently.” [8]

To accomplish these goals of increased consciousness, effectiveness, and efficiency in a patient’s life, self-action leadership is required of the patient. This is because no therapist (no matter how effective), and no pill (no matter how efficacious) can fix the problems (internal or external) of an individual who lacks the will to change.

Peck further emphasizes that if psychotherapeutic processes are to be successful, the onus for progress falls primarily on the patient, not on the shoulders of the health care professional. It requires a heightened “awareness of [one’s] own feelings and imperfections,” [9] a “willingness to think in broader ways or to handle different situations creatively,” [10] a willingness to “tolerate pain,” [11] “great internal strength,” [12] and “self-control.” [13] Peck equates “a high degree of consciousness” and “self-control” with “psychological competence,” [14] which is the goal of therapy. Hence, victims of mental illness, especially neurotic (as opposed to psychotic) [15] illnesses are, in the final analysis, only victims if they choose to be.

All my mental health related study, self-action research, and experiences corroborate Peck’s paradigm of personal responsibility in effectively treating non-psychotic mental illness. There are many things that can palliate symptoms of neurosis; but the choice to improve and heal must ultimately be made by an individual.

My motivation to get help came in part from observing my dad’s experiences with bipolar disorder. It also came from a deep desire to transcend my neurosis in order to accomplish important life goals (especially as they related to marriage, family, schooling, and my career). Over time, I gradually came to know that if I did not take full responsibility for my OCD, I would relinquish control of my life and fail to obtain the future I wanted.

In high school, while I was still just learning about OCD, I completed a research paper on the subject. One particularly powerful article by Mark Simblist, an Australian homeopathic doctor, resonated deeply with me. In his article, Simblist writes:

Our aim should be to raise a victim’s awareness to the level where they know they have a choice – a choice to think what they want to think and a choice not to be victims of intrusive thoughts or compulsions any more. This naturally involves healing very negative thought patterns built up over years and releasing bottled up emotions…. In general I think patients will need to take responsibility for their condition and work quite intensely with a number of different healing methods, particularly some form of therapy, and be prepared to make changes to their lifestyle…. Most of all, patients must realise that compulsive behaviour [sic] began with a choice at some level, and conscious choice is the key to breaking it. [16]

It was in the spirit of Simblist’s words that I proactively pursued professional help in connection with self-help strategies to confront my illness. I felt empowered and emboldened by the concept that choice plays a key role in defeating mental illness, including OCD. Every time I visited a professional, even as a minor, I did so willingly. I do not say this to impress you, but to impress upon you that the operative word in holistic healing is always will. While medication may mitigate symptoms along the way, a patient’s will to be honest with oneself and work very hard are the only lasting keys to success.

From ages 13-17, I did not know I had OCD. I just thought I was “different” and “weird.” As an adolescent, I hid my obsessions and compulsions as best I could. Even when I was not hiding from those seeking to help me, such as my parents, I did not have sufficient knowledge of abnormal psychology to understand what was really going on. While my parents were supportive and loving through this difficult period, they were also quite ignorant of what was wrong and specifically how they could help me.

My dad’s struggle with bipolar disorder was instrumental in helping me discover my OCD. As I observed the deep distress he faced, which nearly led to his suicide, the thought occurred to me that maybe I also had something wrong with my mind, albeit with a different name. I started doing research in the small library of my rural high school. I first found a book with information on agoraphobia. Some of the symptoms looked familiar, but it did not describe my issues precisely. My next step involved browsing the Internet, which had just recently come to our community. Before long, I came across some information about OCD, and the more I read, the more certain I became that I had found a correct diagnosis. This was a glorious occasion because it helped dispel the idea that I was “just weird.” It also produced hope for help and healing.

Several months later, in January 1997, I visited the same psychiatrist who had diagnosed my dad with bipolar the previous summer. He officially diagnosed me with OCD and wrote me a prescription for Luvox (fluvoxamine). Thus began an extended period of medication for OCD that would continue intermittently up until the present day (2015). I recall feeling much better after going on medication, but was frustrated by my inability to precisely identify how much of my improvement was caused by improving external circumstances versus the direct impact of the medication. In hindsight, I think it was a combination of both.

I do not remember exactly when I stopped taking Luvox, but I moved to Spokane, Washington in August 1997 (six months or so after I began taking medication) and I do not recall taking the medication in Spokane. It is possible this played a minor role in the overall difficulty of my senior year in Washington.

While in Spokane, I met with a counselor at LDS Social Services [17] a couple of times in 1998. That fall, I had a couple more sessions with a different counselor in Denver, Colorado.

On my mission, I met with my mission president every four to six weeks for a personal interview. Over time, it became increasingly evident to him that I needed counseling beyond what he was able to provide. He referred me to LDS Social Services where I attended four or five professional counseling sessions, which were both illuminating and encouraging.

After returning from my mission, I had a profoundly difficult and disappointing romantic letdown. The emotional fallout and exacerbation of my OCD symptoms were so severe that I again sought out professional counseling about seven months after returning home. This was the first time I had done so without suggestions from my parents or ecclesiastical leaders.

As a poor college student, I was concerned about how I would pay for professional counseling. Fortunately, I discovered the Comprehensive Clinic at Brigham Young University (BYU) – a counseling center where graduate students in training provided counseling services at a reduced rate. I could get the therapy I needed for only $15 per session, or for free if I could not afford the $15.



Taking advantage of this affordable opportunity, I pursued regular, ongoing therapy for the first time in my life. I started out meeting with my counselor at least once a week, tapering off to once every other week, etc. I continued to meet with her until she moved on from the Comprehensive Clinic. I spent a total of 10 months in therapy on this first go-round. The following journal entries shed some light on my experiences with, and attitudes toward therapy and my counselor.

Thursday, October 11, 2001

I ha[d] a psychological evaluation done today. Met w/ a fellow named ———who got a background idea of my struggle with obsessive-compulsive disorder and depression. I took a personality test as part of it, which was 240 questions long.

I then met w/ my therapist ——— for the second time. Was productive insofar as she helped me identify one of the symptoms of which I had not thought of much before. That is a mind that has thoughts which race and race. She pointed out that even my way of presenting info to her comes out quickly, and jumps from here to there. It was very eye-opening.

Thursday, October 18, 2001

Today I spent four hours at the Comprehensive Clinic. Took a 500+ question evaluation/test, by far the longest I have taken. It included a true/false and personality test. It was easy to take and went quickly, but the sheer quantity of questions was a bit intimidating. Then I took another 90- question test, then waited for my session of therapy w/ ——— which went very well. I learned a lot.

Thursday, October 25, 2001

Had a therapy session w/ ———. It went well. She taught me a relaxing exercise that should be beneficial. I also did some more testing, including an ink-blot test where he would show me some abstract ink blotches, symmetrical in form, and would ask me what I saw in them. My mind obsessively saw sexual images before it saw anything else because that is the most embarrassing thing to see—and then have to say. He recorded everything I said. Afterward I took another true-false personality test of 170 questions or so.

Tues. Oct. 30, 2001

Had an excellent therapy session with ———. I am feeling more comfortable w/ her as our sessions go on. Today’s session was very productive, and I came away with some concrete items to work on.

Sun. November 11, 2001

I think I was very mature tonight. Spent some time w/ a girl named ——— tonight. She is a cute girl. I was proud of myself to be able to talk w/ her and strive to get closer to someone as my psycho-therapist ——— has asked me to strive to do—to just try and get closer to people. In fact she even assigned me a few weeks ago to try to have an emotionally based conversation w/ a female.

Tuesday, November 27, 2001

I went to a therapy session today w/ my therapist ———. She is great. Had a great session and made some progress. Her emphasis of solution is based on really pounding the exposure-response treatment, in ways I haven’t so much done.

Thursday, December 6, 2001

Today I had a review w/ ——— at the clinic of how my psychological assessment went—that was all those tests I took about six weeks ago. Today I had the chance to hear at point blank range, and in plain words of biting sharpness 45 pointed weaknesses or areas of neurosis and cognitive distortions that became evident by the results of the tests.

At the time, I had a hard time holding in the laughter, because it just seemed funny to me. Tonight it doesn’t seem so funny to me anymore. What I see is a re-affirmation of the reality and severity of my neurosis, and an uphill battle yet to fight.

The results of my combined psychometric testing, as described in the entries above, revealed the following data about my psychological state of being.

      Extreme insecurity                    Demanding of self                      Heightened anger
      Demanding of others                 Extreme anxiety                         Skepticism and cynicism
      Health problems                        Overemphasize rationality         Apprehensiveness
      Self-critical                                Plagued by self-doubt                Distortion of problems
      Lack poise in social situations  Over-react to stress                     Depression
      Blunt with others                       Blunt with good motives            Order centered
      Need to achieve                         Unwanted disturbing thoughts   Tendency to brood/ruminate
      Strange thoughts                        Feeling unreal                            Difficulty processing feelings
      Hard on self                               Lack of energy to cope              See myself as weak
      Ambivalence/vacillation           Untrusting of others                   Hyper alert about environment
      Trouble warming up to others… Yet actively seek social life    Internally focused
      Persistent fear response              Arrogant
      Feel some isolation w/ male counterparts because of certain inherent feminine interests
      Might possibly like to participate in child rearing and housekeeping
      Appreciate feeling wrought out in artful endeavors and [have] aesthetic inclinations
      Difficulty incorporating values in my own schema.
      Perceive others’ actions as disingenuous
      Trouble tolerating discomfort—inability to delay gratification for extended period of time
      Lack of family understanding of what I am going through
      Problems with losing control of thought (losing mind)
      Daily activities are boring, unrewarding
      Marked discomfort during interpersonal interactions.

Thursday May 23, 2002

I had an appointment with ——— today. The coolest thing was that I was able to tell her that there really wasn’t a lot to talk about, because I am doing so well as far as working situations through on my own. It was a lovely visit. She asked about how I was doing with the ——— situation and I said okay—and explained that having met ——— was a big help. I took the opportunity to express a heartfelt thanks to her for all she has done. I expressed that she has changed my life, and she in truth has had a critical influence on my life. I am so grateful that I took the initiative to begin this intensive period of therapy, and the results have been astoundingly successful.

Wednesday August 14, 2002

I had my last visit with ——— this morning. She is not going to be doing therapy at the comprehensive clinic anymore. It was a good visit, and I focused mostly on giving her a travel log of my romantic woes I have experienced since I last met with her. It wasn’t the wisest way to go about it, and it led me to feel a bit poorly most of the day, as it induced me to obsess about it all. 

During my counseling at the Comprehensive Clinic, I was also seeing a psychiatrist, albeit far less frequently as he was much more expensive. The main purpose of visiting a psychiatrist was to procure prescriptions. Viewing my medicinal treatments, and therapy in general, as an ongoing Self-Action Research (SAR) project, I expressed an interest in trying something other than Luvox. He suggested I try the selective serotonin reuptake inhibitor (SSRI) Celexa (Citalopram). My journal records are spotty regarding my medicinal treatments, but I do know that I went on the medication in late February 2002, and was still on it eight months later, as the following entry recounts:

Tuesday October 1, 2002

Had an appointment this morning with my psychiatrist, Dr. ———. We decided to try a larger dose of medicine. Things are really looking better, but I am eager to try anything that will help even more. He suggested I definitely stay on the medicine, at least at 20 mgs/day. For now, we are going to bump it up to 40 mgs and see what happens. I really like my doctor. He is a good man.

The most important counsel he offered was that I seek for spiritual help in filling the existential vacuum that I have found myself in so much. He was very impressed at the depth of my understanding of the cognitive end of things, but noticed that I am not as effective at my emotional, feeling side of things.

Fortunately, I was able to remain on my parents’ insurance during this time, which kept my medication costs to a small co-pay fee.

I don’t remember when I went off medication, but I was no longer taking it when I moved to Georgia in August 2003. Some time after I returned to Utah in February 2004, I experienced another melodramatic romantic rejection and crisis. I again found myself in the grasp of severe OCD symptoms, prompting me to return to therapy and medication. This time, the psychiatrist prescribed me Lexapro (Escitalopram). Lexapro is chemically analogous to Celexa, but purports to having lesser side effects.

The following journal entries describe some of my experiences with this next round of therapy with a new counselor who, like my former counselor, was also female. I experienced more ups-and-downs with this counselor, who, despite her sincerity, was not as well suited for me as my previous counselor had been.

May 10-16, 2004

This week was hard. I have been quite depressed. Getting out of bed has been difficult. I have mostly wanted to lay flat on my back. I did run several times and am in the process of getting in shape for the Utah Games.

[My waiter job] is wearing on me. As soon as I can quit that job I will. Joe suggested perhaps a job at a Motel in the evening where I could have time to just read. That appeals.

Had my second counseling appointment this Wednesday. It was good. I really like ———, my counselor. I am extremely disillusioned right now. Don’t know when I will really come out of it.

Mon-Thurs. May 17-20, 2004

Hellish first couple of days. Hard to get out of bed. Very frustrated. Very miserable. Felt like dying—or had desires along the lines of wanting to cease to exist.

Had a good therapy session on Thursday night. I like ———. She is a good therapist, but I think that my situation is stumping her to some degree. It is frustrating and I don’t know how much good is coming of it.

Sun May 23, 2004

Nice day. Had a few minutes to spend with ———, which was nice. The last several days—ever since I had the counseling session with ———, things have really looked up. As frustrating as the counseling session itself was (in the sense that I didn’t feel like we were getting anywhere) it has coincided with a timing that has me going in the right direction mentally and psychologically in a big way.

I feel healthier and less uptight and filled with a heart that is open and forgiving and mature and seeing things again as they really are to an extent that I think the Sun is truly coming out again in my life. It is so fascinating to me how nothing really changes, but when I change internally, my world changes with it, and motivation and love and compassion, and all kinds of wonderful things begin to return.

October 3, 2004

Experienced a lot of anxiety today over ———. This is one of the worst days for that. It will only get better from here—I hope.

October 4, 2004

Was hard to do, but I knew it was the only road I could take—that I wanted to take—to pick myself up once again and keep moving forward. To keep trying—that is the highest of actions.

I resolve to humble myself regarding where I am at with relationships and the obsessive element in that part of my life. I am resolved and committed to going forward and resting not until God enables me through His grace and the fruit of my own efforts to conquer this maddening weakness and struggle just like I have conquered so many challenges in the past.

As I said to ——— my therapist tonight … “this weakness will bow to me.”

Fri. Oct. 15, 2004

Another tough day physically and emotionally. Better emotionally though.

I had a therapy session with ——— this morning. I didn’t feel like I got much out of it. I am thinking about either terminating therapy soon, or else getting a different counselor. Bless ———‘s heart, but I don’t think that I am getting much from her anymore. I am dubious whether she is a good fit for my needs. She does love and care about me though as a client and I appreciate that. It is nice to think that someone out there really does love and care about me and even thinks about me and how I am doing once in a while—not that my family isn’t a great support—because they are, but, at this point in my life, that is still different for me.

The last journal entry I can find that mentions this round of therapy was April 12, 2005. During this same time, my psychiatrist decided to change my medication from Lexapro to Effexor (Venlaxafine). Despite terminating this round of therapy, I would continue with my medication until 2006, when I weaned myself off it gradually and then went off it completely in April.

In conjunction with formal counseling, I also engaged my brother Joe as a lay therapist for the first four years following my mission. I had great respect for Joe, and just as importantly, viewed him as a sterling example of mental hygiene. When comparing Joe’s counseling “services” to the professional (and semi-professional) therapy I have received to date, I can honestly say that Joe held his own, and his billing system was far kinder to my wallet. Particularly in 2001 and 2002, I regularly went to Joe either by phone or in person to talk through a given situation or scenario with which I was struggling. A skilled and patient listener, he was generous with his time and helpful with his counsel. I will always be grateful for the guidance and support he so liberally offered during those difficult years. His presence in my life was a gift from God. My sister Jody also served as a lay therapist for me between 2001 and 2003, especially in relation to my troubles with dating and women. She and her husband and young daughter were a great strength to me socially and emotionally.

After terminating therapy and medication in 2005-06, I was able to remain off medication for five years. It would be nice to report that I did so because my OCD had been cured, but that was not the case. Beginning in 2007, I began experiencing symptoms that once again needed professional help, and in 2008-09, these symptoms worsened.

The most prominent strain of OCD at this period involved existential frustration. I would arise in the morning quite depressed—almost to the point of wishing for non-existence—and it would often take many hours before I was able to snap out of my funk. I delayed seeking out help, mostly out of a fear that my new wife would worry unnecessarily.

There were, however, moments where it was hard to hide my symptoms from her. Whenever I felt caught up in the “existential vacuum,” [18] I would become subdued, un-talkative, and stare off blindly into space. Such moments concerned her, and her concerns filled my heart with fear and dread that my OCD might destroy the most amazing human relationship I’d ever enjoyed.

Fortunately, things worked out with us, but getting married did not signal an end to my struggles. Even though I had been upfront with her about having OCD before we had even started to officially date, the idea of her husband going to professional counseling for mental problems was difficult for her to bear at first. Her concerned tears over the issue pained me, and influenced me to avoid seeking further help.

Things improved in 2009-2010. This was due in large part to my full-time employment as a high school teacher. While my year of in-classroom teaching was one of the most challenging of my life, I did enjoy many aspects of it. Just as importantly, my schedule was sufficiently busy that I did not have much mental time or energy to spare on brooding and obsessing.

In 2011, in the midst of my doctoral sabbatical, I lacked the kind of externally enforced, rigid schedule I had experienced as a full-time teacher. Moreover, I was bearing through a Canadian winter in Newfoundland, which was cold, dark, wet, and snowy. Existential frustrations and other challenges returned. This disquieting combination caused me to finally return to therapy and medication for the first time in years.

Due to an industry shortage in the St. John’s area, it was about four months before I could get an appointment. I entered counseling with a professional psychologist (Ph.D.), and attended approximately eight to ten sessions with her, which I found beneficial. When I finally met with my psychiatrist, he started me off on Anafranil (Clomipramine) and then later switched me to Celexa (Citalopram). The switch to Celexa was made after experiencing meager results – with noticeable side effects – with Anafranil. The doctor was also optimistic of the switch when he learned several of my siblings had experienced positive results with Celexa, and family members typically respond similarly to the same drug.

When my wife and I returned to Houston, I was taking 30 milligrams of Celexa in the morning and 20 milligrams in the evening. I considered the possibility of going off the medication in 2012, but ultimately decided to remain on it until reaching a place of greater homeostasis in my life and career. Furthermore, my symptoms are not as severe when I am on mediation, so why go off it?

As the severity of my symptoms has cycled over the years, the question naturally arises: how do I know when I need to re-enter therapy and/or return to medication? M. Scott Peck has a good answer that I have used as a litmus test for my own needs.

There’s no need for therapy when you’re clearly growing well without it. But when [you]’re not growing, when [you]’re stuck and spinning [y]our wheels, [you]’re obviously in a condition of inefficiency. And whenever there’s a lack of efficiency there is a potentially unnecessary lack of competence. [19]

THE TWO-EDGED SWORD OF OCD


At the conclusion of my missionary service in 2001, my mission president interviewed me for the final time. In the course of my final interview, he made a comment I’ll never forget. As a reference to my capacity for hard work and obedience, he said, “OCD has not been all bad for you Elder Jensen.” Far from lionizing the disorder, President Andrus taught me an important life lesson about the freedom I possessed to choose my own destiny regardless of my challenges.

The more I have reflected on his words, the more I have realized that my greatest strengths are – like a two-sided coin, or a two-edged sword – often the other side of my greatness weaknesses. The same mental capacities that spiral into agonizing obsession and melancholy also produce tremendous agility and focus. They empower me to assimilate, organize, synthesize, and communicate information in an organized and articulate manner. Thus, whether the disorder overtakes me or whether I utilize the same capacities as positive strengths, is a choice over which I have power.

The ever-looming question then becomes, which will I choose to embrace? Which side of the two-edged sword will I choose to keep sharp, and which side will I work to dull over time? Thank God for the freedom and sovereignty to make my own decisions each day in the matter. As I have exercised SAL, and otherwise sought to overcome my disorder, I have been blessed with the positive feelings of satisfaction and fulfillment associated with overcoming difficulties, setting and achieving goals, and experiencing enormous Existential Growth. This has done wonders for my self-esteem and confidence.

A Two-Edged Sword [20]

OCD:
What has it done for me?
Is it my friend?
Or my enemy?

The answer,
You see,
Though I’ve
Oft been its slave—

Pathological knave!—
Made me crave for the grave,
Yet somehow . . .
It managed to
Set me free!

Yes it does rather seem
That my nightmare extreme,
Sometimes guised as a dream—
And a good one forsooth!
For in truth,
I behold
That for brain hygiene’s gold,
I must work hard to mine,
Spending mountains of time,
Sweating tears as I pine,
Many years ere I find,
That the cure for my mind—
So oft plagued by the grind—
Is just like that gold,
Mixed betwixt all the old,
Common, cheap, rocky ore,
Whose plentiful store
Hides all worth
Worth pursuing,
Investing,
Accruing,
There’s no need for
Stewing,
For Freedom’s
Now
Mine,
And ever can be
Into eternity
If I’ll never
Forget
That the price
Involves sweat and
Avoiding regret,
And that I’m only set
When I see I’m not yet,
And then rightly perceive
That in time I’ll receive
A most pleasant reprieve
That’s as grand, I believe
As it badly began,
As if Alchemy’s claim
Held water—not sand.
So I’ll keep on the fight,
Through each day,
And each night,
With a calm, tranquil might,
That affirms I’m all right.
And ne’er e’er forgetting,
The puzzling piece
Of the pie
Peck [21] calls
Grace—
So truly Amazing—
To see its pow’r
Razing
My mind’s ills
Erasing.

Yes, there’s help from my pills,
My shrink and SAL to boot,
But shoot!
What a pathetic hoot!
I would be
On my own,
All though I’m now full grown,
And have carefully sown
Seeds of thoughtful decision,
Crafting nobly a vision:
Important!
Yes all,
But lest I should fall,
I will never
Forget
The Source
That doth heal.

With salve that is real—
As real as You—
And me,
And OCD,
And the help,
And the cure—or
The management—
Here, and
Now,
As I await its ultimate
Eradication
THEN . . .
By Him
As long as
I
Do
My
Part
Now.

In striving to effectively manage OCD in my life, a key to my success has been recognizing that the goal is not necessarily perfection, but PROGRESS

Progress [22]

Alas, my inmost heart breaks free,
From all that has been stopping me,
And I exult in all that will,
Break forth into my life yet still.

There is still so much more to learn,
Things to achieve and things to earn,
Folks to meet—my heart doth burn—
As for it all I greatly yearn!

This anxious state amidst it all,
Oft seems to be my life’s true call,
Yet spite the pain and petty pelf,
I’ll still claim victory over self.

And meantime I’ll enjoy the ride,
And bask in the abundance here,
My life will be serene inside,
And outside I’ll be filled with cheer.

THE POWER OF A PURPOSE


Knowing I have a choice in matters of mental health empowered me to seek out help and achieve the mental hygiene I so desperately needed. Along the way, I learned there is more to mental hygiene than therapy and medication. The most important variable of all is to have a purpose for living beyond myself. Therapy and medication can be important, even essential, steps along the way. However, relying on medication and therapy beyond the scope of their capacity to alleviate symptoms and rebuild healthy cognitive function will only result in long-term failure.

To contrast these three variables in healing, consider an analogue to a physical ailment – a broken bone. If I break my leg, having the bone reset and placed in a cast is like getting therapy. Receiving pain medication is like getting medication to ease my symptoms. But can anything be more powerful and motivating than having a driving desire to use my fully functioning leg for some grand purpose (e.g., working to provide for my family, running a marathon, or exercising my mobility to serve and bless the lives of others)? I believe most, if not all, physical healings judged to be miraculous result from patients whose will to heal and live is influenced by some purpose beyond themselves. Whether it is a parent striving to live for his children, an employee needing to get back to work to contribute meaningfully to her company, or an elite athlete dedicated to one’s sport, having a purpose is powerful.

The healthiest periods of my life were not always the times I was in therapy or on medication, but when I was most engaged in work I enjoyed, found meaningful, and provided service to others. For example, despite the enormous challenges involved in teaching high school, I was considerably healthy mentally during this time period because of the structure it provided to my schedule, and the responsibility I had to serve others in meaningful ways.

When my wife and I had our first child, some asked me about the difficulty of our new responsibility. Despite any difficulties, irritations, and inconveniences involved in being a parent, I thank God for the enormous purpose I have found in raising my son, and in nurturing my relationship with his mother. This vital work transcends virtually all other purposes in my life. As a result, having a child has actually improved my mental hygiene.

This isn’t to encourage someone to go out and have a child in an effort to battle mental illness. Such a decision could be disastrous if you’re already dealing with psychosis or severe neurosis. Remember that I had been working on my illness for over a decade in preparation for fatherhood. But when you are healthy enough, and if you are in a positive and healthy relationship with your co-care giver, child rearing can actually bolster your mental hygiene because of the profound purpose it provides.

If you do not have a driving purpose in your life, I encourage you to find one. If you had a purpose, but lost it, I encourage you to strive to regain it. If you don’t feel like working to find a purpose, I suggest willing yourself to the task until you do feel like it. If you persist, I promise you will eventually find or regain it. If you fail, you are apt to give up on life. But remember, the only true failure is quitting. If you are interested in long-term mental hygiene, I believe there is no better remedy than having a compelling purpose that transcends self. Such a purpose will be the catalyst for getting help, for trying every day, and for moving forward.

MY QUEST TO BECOME EASY-GOING


Another piece of advice my mission president gave me at the end of my mission was to be good to myself. People with OCD are typically not those in danger of committing high crimes and misdemeanors, although personal gaffes and other minor mistakes may sometimes feel that serious to someone with OCD. Coming from a spiritual leader I greatly respected, this advice has benefitted me enormously in my battle with OCD and depression.

OCD influenced me to be an uptight, intense, and austere person. These characteristics were not lost on others. For example, one of my missionary companions nicknamed me, “Stress-Bomb.” My mission president himself once remarked that I would never be an easy-going person. Instead of viewing my mission president’s prediction as a foregone conclusion, I took it as a challenge to change.

I take great pride in the fact that I have become more relaxed and easy-going over the years. I still take important things seriously; doing so is one of my greatest strengths. But I don’t sweat the small stuff like I used to, and I am much more relaxed socially than I was before my diagnosis. In fact, I take great pride whenever I catch myself being easy-going.

GOOD AT OCD


My second counselor at the Comprehensive Clinic once said to me, “Jordan, you are really good at OCD!” I was unsure what she meant at first, but she went on to explain that I am really good at becoming self-aware of my own mental status, identifying where I need to improve, and then doing something about it. This has turned out to be one of the more memorable and meaningful compliments of my life. I like the idea that I can be “good at OCD.” It means I have chosen to not be a victim, and that I can break free of my psychological shackles; it demonstrates that I possess power over challenges I face in my life. Finally, it promotes the potential I have to accentuate the positive side of the two-edged monster-genius of OCD and depression.

THE WAR GOES ON


I wish I could say today that I am fully “cured” of my OCD. Unfortunately, despite the significant progress I have made, I am not cured. In fact, the battle goes on most days of my life, and it is doubtful I will ever transcend it entirely in this life, and that is okay. The trick I’ve discovered is not to live on false hope for complete healing, but to reasonably, practically, and faithfully work for adequate management and ongoing improvement. [23] Consider the following journal entry from a decade ago.

Sat. Jun. 8, 2002

Neurosis is not something that is usually overcome completely. In the words of Dr. ———, and I paraphrase—“the [goal] with OCD is to work with is so that it becomes a faint hum in the background of your mind and life, instead of a blaring horn in the forefront of your conscious experience.”

I have been in and out of therapy many times since 1997, the most recent being just last year. I also take medication daily right now, and am grateful for the way in which it takes the “edge” off of my symptoms. Chances are good I will need to continue medication and therapy to varying degrees throughout my life. I am okay with this fact, and stand ready to do whatever is necessary to ensure I control my OCD and depression, rather than letting them control me.

Many battles have been won, but the war goes on, and will probably do so until the day I die. My hope lies in recognizing the enormous progress I have made, seizing opportunities for further progress, and exercising my potential to provide help and hope to others who struggle similarly in their own lives.


[1] For a great article that outlines a dozen different “flavors” of OCD, see Weg, A.H. (2011). Living with OCD: Strategies and Treatments for Anxiety Disorders and Compulsive Behaviors. Psychology Today (Online). Published July 16, 2011. URL: http://www.psychologytoday.com/blog/living-ocd/201107/the-many-flavors-ocd
[2] Penzel, F. (2013). To Be or Not to Be, That is the Obsession: Existential and Philosophical OCD. Newsletter of the International OCD Foundation (IOCDF). Volume 27, Number 4 (Fall/Winter 2013). Boston, MA. Page 15.
[3] Previously unpublished.
[4] Reprinted from Rolfe, W. J. (1889). Select Poems of William Wordsworth (Google Books version). Pages 120-121.
[5] Reprinted from Jensen, J. R. (2012). Psalms of Life: A Poetry Collection. Bloomington, IN: author House. Page 48.
[6] Peck, M. S. (1978). The Road Less Traveled. New York, NY: Touchstone. Page 16-17.
[7] Peck, M. S. (1997). The Road Less Traveled and Beyond: Spiritual Growth in an Age of Anxiety. New York, NY: Touchstone. Page 75.
[8] Ibid. Page 78.
[9] Ibid. Page 79.
[10] Ibid. Page 77.
[11] Ibid. Page 75.
[12] Ibid. Page 85.
[13] Ibid. Page 81.
[14] Ibid. Page 81.
[15] When mental illness advances beyond the stages of neurosis to more advanced stages of psychosis, there is a point when an otherwise autonomous individual capable of growing through their mental illness may no longer be reasonably accountable for their mental state and/or physical actions. The diagnosis and assessment of neurosis and/or psychosis is the business of licensed mental health care professionals, and should not involve casual guesswork.
[16] Simblist, M. (1998). Homeopathy and Obsessive-Compulsive Disorder. The Journal of Australian Homeopathic Association Inc. Volume 11, Issue 2, p. 18-21. Page 19.
[17] Presently known as LDS Family Services, the professional counseling arm of the LDS Church.
[18] Frankl, V. E. (2006). Man's Search for Meaning. Boston, MA: Beacon Press. Page 106.
[19] Peck, M. S. (1997). The Road Less Traveled and Beyond: Spiritual Growth in an Age of Anxiety. New York, NY: Touchstone. Page 76.
[20] Reprinted with slight revisions from Jensen, J. R. (2012). Psalms of Life: A Poetry Collection. Bloomington, IN: authorHouse. Pages 56-58.
[21] A reference to M. Scott Peck, M.D.
[22] Reprinted from Jensen, J. R. (2012). Psalms of Life: A Poetry Collection. Bloomington, IN: authorHouse. Page 149.
[23] In this sentence, “faithfully” refers to faith in God, faith in others who can help me, faith in helpful available information, and most importantly, faith in my own capacity, power, and will to act.

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