Coping With Uncertainty – Your Don’t Ritualize Enough

Recently I answered a question on a list-serv.  The author noted that ERP wouldn’t work for her, because she wasn’t worried about immediate consequences, but disasters that might result in the future.  I let her know that the point of ERP is NEVER to prove anything is safe, but to assist in learning to live with uncertainty.  Her issue was chemicals, so I thought it would helpful to explain why her rituals weren’t complete enough.  My answer to her is below.   Even if you don’t have contamination, think about how you would apply these same ideas as to why your own rituals are inadequate.

My Answer: The goal of ERP is NEVER to prove that anything is safe. The goal of treatment is deciding the you need to learn to live with uncertainty. The world is full of low and high probability dangers. You are at greater risk to be in a car accident than you are to suffer from your fears and yet you might risk death to see a movie – why would you do that?  Do you check your car tire pressure daily to insure proper inflation to maximize control and braking ability of your car?  Do you talk on a cell phone when you drive?  Do you every drink coffee/soda or eat when you drive? Do you talk to others which can be distracting or listen to the radio. Do you ever drive with a single drink in you which is legal, but still should change the odds.

Since you admit to having OCD, what do you want your relationship to your son to be? Do you want to be the mother whom he makes fun of to his friends when he is in HS? Or since he has a 1 in 4 chance of having OCD, do you want him to learn that it is something he can learn to cope with or do you want him to follow your example? If you choose the latter, the sad part is that his health won’t be significantly protected from your actions, but OCD will rule his life. After all, I don’t know what chemicals/germs you are concerned about, but if he isn’t wearing a mask in school, then he risks illness, because the germs aren’t going to wait until he gets home. Is he to have no contact with other children? Canhe never go to a friend’s house, because you don’t know what lawns they may play on and if they have been treated. Do you live in a pollution free arean(eg the middle of Montana with no industry or farming that uses chemical fertilizers)?  How are you with food additives?  Is he ever going to learn to drive?

If you are going to guard against low probability events, then you need to work much harder at isolating your family and teaching your children to live
in fear of the world? They won’t be normal, they actually won’t be safer, but you’ll feel better for having given into fear.

You actually have 2 problems. The obvious one is OCD and the other is an avoidance of a fear that every parent has – we can’t protect our children.
There are a million ways for them to die, diseases that don’t have obvious external causes, falling down, others and the only thing that saves them is
luck. Because although it is true it is safer to walk on the sidewalk than the middle of the street, walking on the sidewalk is not a guarantee that a
car won’t hit them.

The truth is that OCD is about wanting absolute certainty and there is a reason you can’t have it. Research has shown that the only people who are
certain are stupid people.  OCD sufferers are usually above average intelligence and we don’t know how to make you stupid, so you will have to settle for second best: coping with uncertainty.

The truth about your loved ones is that when they aren’t in your presence, they are a memory of good times past and a hope you will see them again.
The only time you have them is when you are with them. But if you have OCD, you don’t even  have that. So if your son dies in 3 yrs you will have
missed those precious years. And if outlives you, you will miss his lifetime. Can you learn to live with uncertainty? We know you can, because in the above paragraphs , I hopefully mentioned concerns that you don’t have; even though, they carry horrible risks. You can be sure that there is another OCD sufferer
whose fears were touched in the above paragraphs. The goal of treatment is to learn how to experience OCD fears the way you experience the uncertainties
you cope with. It is true there are some therapists who wrongly suggest that ERP proves something?  Yes and your observation that ERP couldn’t establish that anything is safe was reasonable.   Luckily certainty isn’t the  goal of treatment.  Again, think about the car accidents that aren’t a part of your fears.  You don’t demand absolute safety upon getting into the car; and your plan for handling a disastrous accident is to wait for it to happen.  With  your OCD fears you attempt to know now.  That is what you can learn to change.

These same ideas about all of the things that you don’t check for can be applied to any OCD problem you have, whether it be scrupulosity, violent thoughts, checking and so on.  The conclusion is always the same, it isn’t possible to ritualize enough to be safe, so you need to decide to be more miserable with no benefit or learning to live with uncertainty and finding freedom.

8 Comments

    • Christina,
      Sorry for the delayed response. You are asking a very important question, but a very big one. I don’t usually mention my book, but violent obsessions are covered in it. However, since these are a form of OCD, if you do decide to read my book, it is important to read the chapters that discuss the nature of OCD in general before turning to the specific chapter.

  • Wow, this is a great response. Those with OCD certainly feel that they are in control, when everything you state is true. If I talk on a cell phone while driving, I am putting myself in peril. Of course I don’t think about that. I only think about the dangers of whatever it is I am currently obsessing about.

    Another one will done, Dr. Grayson.

  • Hello, very good article. I like the ideas about ritualizing.

    I have been struggling with some post partum OCD related thoughts since my first child was born 9 months ago. My main issue is I have fears about carrying him across high places like our staircase in our house. I used to really ritualizeoveranalyze about the thoughts but after learning about OCD I realize that this doesn’t do any good and never gives me any real solution. I’m curious if ERP would help for this type of issue? I dont ritualize much about it, but It’s frustrating when I can’t seem to cross the stairs with him without having a thought about it. Should I just accept that maybe I’m always going to have this thought in this situation or could ERP help?

  • What about convincing a patient, with certainty, that they have OCD? This is not meant at all facetiously, but being told with certainty that what I’m experiencing is secondary to OCD would be reassuring . . .

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