Tag Archives: Acceptance
Stuart Ralph’s The OCD Stories has just released his second interview with me. We discussed OCD Recovery, treatment resistance and listener questions. To listen, click below:
Max in a post to this site asked what about convincing someone, with certainty, that they have OCD, since this would be comforting and reassuring. There are three problems with this approach. First, as I’ve noted elsewhere, research has shown us that the only people who have absolute certainty are stupid, which eliminates this as a possibility for most OCD sufferers. Seriously, we find that attempts to reassure oneself by saying ‘x’ is OCD followed by the comfort that I don’t have to worry about ‘x,’ tends to be a short run solution. Usually the sufferer at some point will then begin to obsess and try to reassure him/herself that the problem is OCD and the circle goes round and round (this is 2 of the three points). We are for the sufferer admitting that it is likely that they have OCD, but that this is independent of whether or not there feared consequences are avoidable. For example, if your OCD issues focus on wanting your loved ones to never die, the fact this is an OCD concern is independent of the fact that your loved ones might die at any time, so treatment has to help you cope with this fact of life. Now it is true that some OCD concerns may involve lower probability fears, but that isn’t relevant to treatment. Whatever you fear is what the focus of treatment needs to be on. The goal is always twofold: I need to cope with the uncertainty that ‘x’ may happen; and no matter how horrific ‘x’ is, I need to try to figure out a positive way to cope with it, if it does happen.
Patrick, I assume you read the post article here about obsessing about obsessing, so I will not repeat what was there. This form of OCD is a difficult one to help a sufferer understand what to do and I apologize if this doesn’t seem clear. In your post you ask if you should ruminate and I would re-word that to say exposure, since ruminating suggests ritualizing to me. You mention that you have a number of feared consequences (e.g. becoming poor) that you say may happen. This would not be enough. How would you attempt to cope with them in a positive way. How would you get on welfare and make the best of it. So part of the exposure would be very detailed that if these things happened what would I do. The reason for this is that if these things actually happened, life would go on and a person would have to continue. Though being poor would be very difficult, people in dire straits can still have enjoyment, even if it is less in their life.
Second, whenever you are doing something, we would like some attention paid to whatever good is actually going on. While learning to overcome this form OCD, it is important to learn how to notice whatever level of enjoyment is present, whether it be 80%, 50% or just 10%. It is learning to accept that this is my current best and so I might as well get something out of it.
The goal is learning to be able to have the thoughts in your head and feel anxious and learning how to cope with this while it is happening. This is very easy for me to say and it is lots of work to learn how to do. Obviously if it were easy enough to explain it all in a post, you would have figured it out on your own. But you can learn how to do this. Finally, it is true that OCD is both learned and biological. I have given you some advice for the learned part and an OCD specialist would be useful for you to be seeing. Medication would quite likely be a very helpful addition to your treatment and it is usually in the form of an SSRI for those who suffer from OCD. I hope this provides you with some help and hope.
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.
Amanda’s suffers from fears of being gay and says that she has read my book and understands that she needs to accept the possibility of being gay to get better (see book for why this is so). However, she then goes on to say that she thinks she may have arousal feelings and this might make it true and that she doesn’t want to accept.
Amanda, you are raising the most important issue about acceptance. To work on accepting the possibility is exactly what you are not doing. And notice how I’m writing this — I’m not saying accept the possibility, because if it were that easy, your problems would be solved in minutes. Acceptance of something we don’t want is an effort and is painful, but it is usually necessary, because the alternative is living in fantasy. Specifically, for you to work on accepting the possibility of being gay means that you would need to consider how you would make your life worthwhile if you suddenly decide you are gay, as opposed to saying it’s possible, but I know that I’m not. You may ask why, so allow me to give you a few examples not involving your particular fear.
- To not accept means the individual is in denial, which translates to trying to compare real life to a fantasy. When someone loses a loved one, the statement of denial is: life would be better if they were still here. This may be true, but it is a fantasy, since the lost person will never be back. In this case, acceptance doesn’t mean you don’t care about the loss, but it does mean that you stop comparing your real life to the one where the loved one is still here. You may miss them at times. You may cry for them. But when you are doing something, you would enjoy it rather than wishing for your loved one.
- This brings up an important point, mourning – the process of moving from denial to acceptance takes time. No matter how self-aware someone is, when they lose a loved one, they start in denial. To move and work towards acceptance takes time. What you can decide is that you want to do this. Without this decision, the process won’t begin.
- The problem with acceptance is that there is always a loss — and it doesn’t matter if you intellectually know the truth, denial is in the wishing. Again, anyone who has lost a loved one knows they are dead, it is the comparing their current life to the one where their loved one hasn’t died that is denial. Mourning is giving up this wishing.
- Amanda, for your OCD, you fear you may be gay. So one loss is accepting this as a real possibility. To accept uncertainty means accepting that you really may be. So the second loss is that certainty over this issue will never be had, but learning to not care about it is possible. What would this look like? At present, you seem to know that you don’t want to live a gay lifestyle, so you don’t have to. Even if you decide that you are 100% gay, you could still choose to live as a straight person. So your exposure isn’t saying your gay, but it is saying that if a time comes that I want to live as a gay person, then I will have to figure out how to do it. Until then, I’ll keep living this way and will work on trying to not figure it out, because I also have OCD and I also have to work on accepting that I can’t know anything with certainty and part of the reason for this is that research has shown that the only people who have any certainty are stupid people.
- It is true you don’t like this and would like to figure it out, but that won’t happen. Again, the best you get is not right now. It’s true you wish this change won’t occur, but there are a million things you don’t want to happen that you live with — you don’t want to be a mother whose child dies of a horrible disease or gets kidnapped, you don’t want to be maimed and paralyzed in a car crash, you don’t want to get a fatal cancer and on and on. The goal isn’t to know whether or not you are gay, but to work on deciding that if it happens, then you will work on making the best of it. Why would you do this? Because what choice would you have? Will this be your future? Will you live long enough to find out? Maybe.
- All we have is the present. The past is pleasant memories, the future is hope. When you have OCD, you don’t even get the present, so the purpose of choosing to do exposure and to work on acceptance is to have a life where you get to enjoy whatever you have. The failure is never in falling down, it’s in not trying to get up.