OCD Requires Mental Gardening


OCD REQUIRES MENTAL GARDENING
By Ginger E. Blume, Ph.D.
 
For three decades, I’ve met with clients in my private practice who suffer with an anxiety disorder called, Obsessive Compulsive Disorder (OCD).  This disorder manifests with troubling obsessive thoughts and/or compulsive repetitive behaviors that are time consuming, cause extreme distress and interfere with the person’s normal routines of everyday functioning.  The symptoms of OCD may vary from person to person, but the themes of their illness are quite similar.  Indeed, this article will describe the keynote themes that are repeated like a chorus in a song from most OCD sufferers and some practical solutions for gaining control over them.

When unimpeded, the symptoms of OCD tend to grow metaphorically, like wild and hearty weeds in the mental landscape of the OCD sufferer’s mind.  The illness can quickly dominate a fertile mind (genetically predisposed field), leaving little space for the enjoyable flowers and trees of life to flourish.  Many of the techniques described in this article are akin to digging up weeds by their roots (altering one’s mental assumptions by making them more conscious).  Of course, weeding a garden is not much fun, but the long-term results are certainly rewarding.  
 
Theme #1:  OCD forces a focus on past and future time frames.  
Whether obsessing about what I did (past) or what I might do (future) that is bad/wrong, the mental time frame of the OCD sufferer is stuck in the past or the imagined future.  Theoretically and practically speaking, it is nearly impossible to be engaged in obsessions or compulsive rituals when we are living fully in the present moment.  When we stay in the here and now, we literally shut off the oxygen supply to OCD.  It cannot survive in the “here and now.”  

Implication for Wellness:  Focus on living fully in the “here and now.”  This conscious shift in mental focus creates an antidote to OCD.  Various strategies help us to do this, such as gestalt therapy awareness exercises, meditation, mindfulness practices, yoga, etc.   
 
Theme #2:  OCD forces a focus on what I “do not want” versus on what I “want.”
OCD obsessive thoughts thrive in a mental landscape of what you do “not want.”  These “not wants” are typically expressed in thoughts such as, “What if…I forgot to shut off the water and the house is flooded?”  The OCD mind is focused on various fears about possible unwanted events and outcomes (illness/harm to others/blasphemous thoughts).
 
In contrast, the Non-OCD individual is more often motivated by “wants.”  These wants are like an internal compass, helping guide one toward what is desired in life. We naturally notice what the mind is thinking about.  For example, we’ve all had the experience of purchasing a new car (i.e. a Saab) and suddenly, noticing all the Saabs on the road that we never observed before.  When we scan the world on a daily basis for “our wants” versus our “not wants” we’re more likely to obtain our wants and be happy. 

Implication for Wellness:  Focus on “what you want,” not what you fear or don’t want.  For instance, if I’m aware that I want to get to work on time, I must focus on “keeping moving” versus staying to check and recheck for a household appliance that might still be turned on.  In other words, the “wants” in our mind are an antidote to OCD “not wants.”  
 
Theme #3:  OCD forces a focus on “certainty” versus “shades of gray.”
Woody Allen wisely observed that the only thing we can be certain of is death.  When he used the word “certain,” he meant something we can know without a shadow (shade of gray) of a doubt.  In reality, there are so few certainties, that living a life searching for them is ludicrous.  Yet, isn’t that what the OCD illness would have people do?  OCD sufferers almost never consider shades of gray.  For instance, OCD illness demands that we be “sure” about our advice to our children, so we become inhibited to say anything in case we might be wrong.  As a result, life becomes a series of black or white decisions and outcomes with no room for reasonable life circumstances. 
 
Non-OCD thinkers naturally experience the world in relative terms filled with numerous shades of gray.   For instance, in principle, it is wise to wash your hands before eating.  However, if this weren’t possible in a certain situation, the non-OCD person would not hesitate to still eat. 

Implication for Wellness:  Role-play with someone on being able to recognize reasonable shades of gray in your life.  This involves learning to identify outcomes that are “good enough” (a shade of gray) versus holding out for “perfect.”

Theme #4:  OCD forces one to accept no risks.
In reality, educated risks make life juicy (a shade of gray) versus too dangerous (black or white).  In reality, we can’t do anything without acknowledging that the act of living is about risks.  Risks come in various forms, but they also allow for joy.  Observe an infant playing peek-a-boo.  The risk of not finding mother after she disappears is balanced by the joy of finding her again and again.  Through this simple game, the infant is unconsciously learning that some risks are fun.  Not all risks are terrible and catastrophic.  

Implications for Wellness:  Seek out reasonable risks that have the potential of bringing joy to your life.  
 
Theme #5:  OCD focuses on possibilities, not probabilities.
OCD obsessions and compulsions derive some of their bizarre quality from the fact that OCD doesn’t distinguish between possibility and probability.  Obsessions and compulsive behaviors occur because the OCD mind says, “This could happen,” or “What if this happens.”  The OCD mind is focused on “pure possibilities.”  But, while most anything is possible, how probable is it?  Again, due to black and white thinking, the OCD sufferer often feels justified in worrying about something that is possible, yet highly improbable because they don’t consider the shade of gray that probability implies.  

Implications for Wellness:  The concept of probability can be used in a graduated fashion to help an OCD sufferer slowly eliminate questionable obsessions and compulsions.  You can decide to carry out an OCD compulsion only if the probability of unwanted consequences is 40% or better, hence eliminating a lot of doubt.  Then, you can commit to eliminate those compulsions with only a 25% or better probability of “X” occurring, etc.  The probabilities represent an educated guess or likelihood of “X” occurring. A person without OCD can help you assess this probability. 

Summary:
These five themes are all helpful mental frames for effectively overcoming one’s OCD.  They honor the fact that as human beings, we have a need to “understand why.”  When OCD has been a way of life for a significant period of time, it is painful and risky for the individual to restructure their understanding of life (i.e. some of the mental models of reality must change).  To often, the OCD sufferer has identified with his/her OCD, rather than realize that the OCD is more like a weed in their fabulous garden.  They are “not their OCD,” but rather, they “have OCD.”  
 
I’ve come to view the OCD sufferer’s faulty assumptions as invasive weeds that crowd out normal functioning in their mental and emotional garden of life.  Because these weeds are genetically hardy and programmed to dominate the mind, sometimes, they are all that is visible in an individual’s life.  Once the garden is weeded, talents and creativity that were starved by the OCD weeds sapping all of the individual’s energy are finally able to thrive.   

Part II:
Continuing thoughts on “Mental Gardening:  Crowding out OCD Weeds.” 
  
As described in Part I of this article OCD symptoms are like hardy weeds in a garden.  They need to be constantly watched and pulled at the first sign of growth. Otherwise, they can overtake the beauty of the metaphoric emotional garden and the joy of one’s life.  This follow up article elaborates on some more anti-weed solutions to help your internal garden flourish.
 
Perfection is a dead end street:
People who suffer with OCD understand the problems created in their lives when perfection becomes the benchmark for everything.  With some psychological distance from one’s symptoms, it usually becomes apparent that an OCD sufferer’s search for “perfectionism” is futile.  This intellectual understanding is at least a starting point, but then what?  
 
I try to help client’s make a distinction between striving for “perfection” and striving for “excellence.”  Whenever one is searching for perfection, it is best to mentally label that search as part of one’s OCD disorder.  In contrast, a striving for excellence is much more personal and tied to one’s strengths.  When I search for excellence, it means that I seek to do my personal best on those things that matter most to me.  Ah, the hitch is “those things that really matter most to me.”  Not everything has the same priority to me once I’m willing to abandon the concept of perfection.  And, when I search for excellence, I realize that my priorities are not necessarily the same as other people. 
 
This is where, “Let’s pretend” enters in as a useful strategy.  The individual says to him/herself, “Let’s pretend that I don’t have OCD and I want to chose two key priorities in my life.  The mental frame is one of “reasonableness.”  If I were being reasonable with myself, what would I say really matters most to ME right NOW.  By “pretending” to know, one is forced to choose two things (i.e. completing my college degree and learning to play the piano) and to behave “as if” those were indeed the priorities.  The commitment to engage in the pretend process helps unlock an OCD person’s fear of choosing the wrong thing (which only results in not choosing and getting nowhere).  Yes, better to precede living life than remain frozen in fear.
 
This “pretend” process will sound like a highly arbitrary strategy to many clients.  I remind clients that their subconscious mind becomes highly involved in the “pretend strategy” (after all, that is the part of oneself that is involved in dreams, daydreams, play, creativity, etc.) and therefore, is quite helpful in setting priorities.  In actuality, this strategy is quite easy to do.  What is difficult is getting the OCD client to try it.  Most of the change process involves taking a “leap of faith,” something that isn’t easy, but becomes easier once the individual has decided that living with OCD is simply too difficult if it remains unchanged.  In essence, a type of “hitting bottom” is sometimes the only push for someone with OCD to take a different approach from what their OCD has always demanded of them.
 
What is Just Good Enough?
This is the big question that most of my clients struggle with.  Once priorities are identified, what happens to those things that fall under the category of “nonpriorities?”  Those items (i.e. for me, they include elaborate house cleaning, yard work, exercise, etc.) can be done to the level of just “good enough.”  This might be defined as “what is usually acceptable to the average person.”  For the OCD sufferer to understand this concept requires a willingness to engage in the process of inquiry.
 
Why?  A majority of my clients with OCD tell me they have no idea what is “good enough or acceptable”.  If a person grew up in a highly dysfunctional family, this gap in their knowledge would not be surprising.  But, what about those people who grew up in a fairly functional household.  Why don’t they have a clue about what is normal?  
 
We learn about “normal” while growing up through shared experiences with others.  I believe that during childhood, people with OCD often miss a lot of information about “normal experiences” for two major reasons:  anxiety and secrecy.  Anxiety disrupts everyday learning, especially since the mind is scanning for danger, rather than simply gathering information about people and the world.  OCD sufferers also live a tremendous amount of time inside their heads, in a very private world.  And finally, since many symptoms of OCD seem bizarre (i.e. horrific sexual or aggressive images), the individual is forced to retreat into secrecy.  
 
When one is a keeper of secrets, the amount of normal and open interaction with other people is greatly reduced.  Hence, data/information is missing as the person with OCD becomes increasingly isolated from how others think and feel.  S/he also avoids sharing his/her own feelings and thoughts due to enormous shame.  OCD has been referred to as “the closest disorder.”  Indeed, hiding one’s symptoms is an attempt to protect oneself from negative judgments.  In this process of self-protection, the individual with OCD becomes short-changed on the consensus of “what is good enough” or “normal.”
 
Since these gaps in information about normal or average exist, how does the OCD sufferer make realistic chooses?  For instance, if they usually take 1 hour for a shower in the morning, how do they know what is normal?  The solution is to break silence.  Begin inquiring from others.  One client discovered upon inquiry that the average individual spent six minutes in the shower (occasionally longer if they washed their hair).  This is valuable information.  Like many psychological disorders, OCD thrives in the darkness of shame and secrecy.  
 
Replacement criteria:  Practical, useful, and happier 
Sometimes the OCD sufferer understands they must abandon their old ways of functioning (i.e. seeking perfection/doing just the right thing/etc.), but they don’t know what to replace their old criteria with.  To eliminate arguments about what is the correct way or right way, I urge clients to seek the practical, useful, and/or efficient way.  
 
For instance, a client told me she has to write a thank you note to a friend, but has been putting it off for several weeks for fear it won’t say exactly what it should, etc.  She is beginning to feel guilty for not writing it sooner.  As she spoke, it became clear to both of us that the note wouldn’t get written if her OCD was in charge.   To be practical, she could purchase a thank you note with a sentiment already written inside.  While we both agreed it was ideal to hand write a note, it was not going to happen.   When we switched to the criteria of practical or efficient, the solution was clearer. Remember, this solution is good enough for the average person (otherwise, Hallmark wouldn’t still be in business). 
 
Most things are preferences, not needs:
How many times have you thought to yourself, “I need the books to be arranged just so,” or “I need the bed to be made each morning,” etc.?  This is an OCD fallacy.  There are only a few real survival needs in our lives.  Maslow’s Hierarchy of Needs refers to these basic needs for body survival, such as the need for air, food, water, shelter, etc.    Once these needs are satisfied, we become free to explore higher needs, such as social, ego and self-actualization needs.
 
People with OCD treat all obsessions and compulsions as if they were essential needs.  Their use of language reveals this belief when they said, for example, “I need the shoes in my closet to face the same direction.”  How we talk to ourselves effects us deeply.  It is important to begin relabeling many “OCD needs” as merely “preferences.”  During recovery, remember to ask yourself, “Is this truly a life need or an OCD demand?  If it is not a true need, then relegate it to the position it deserves (i.e. not even on the list). And remember, we can survive just fine if our preferences aren’t met.
 
Who am I?
In order to understand what I’m about to say, let’s first establish one fact:  we are not a  static thing, a static object, or a static noun!  By our very nature as human beings, we are always in a constant state of flux.  Physically, our bodies are continually losing and regaining approximately 15 million cells every second of every day.  Mentally, we are constantly receiving new information, re-evaluating old information, forming new beliefs, updating old ones, etc.  It would be impossible for us to remain stagnant.  
 
Why is this perspective crucial to your recovery?  Because, you must understand that you are a process, not an object, and that your very nature is one of flux.  Therefore, you can change.  You must be open to the fact that you can change. This mindset is crucial in helping you meet the challenges you will face in uprooting OCD weeds.
 
Many of my OCD clients experience an identity crisis when they begin to truly work on eliminating various symptoms.  This is because they have always though of themselves (i.e. part of their identity) as being in large part, “their OCD symptoms”.  To give up their symptoms, therefore, can feel as if one were giving up “who I am.”  I remind clients that they are not their OCD and that we are all growing and changing as human beings.  And yes, people with OCD may have certain natural tendencies (i.e. like things to be fairly neat and orderly), but these preferences/styles are different from OCD compulsions (that demands things be perfectly neat and totally orderly!).  
 
Also, natural preferences are disconnected from anxiety.  One’s preference or style will oftentimes bring degrees of happiness, but they are not demands!  A goal during OCD exposure and response prevention work is to discover one’s preferences and honor those (i.e. they are flowers in the garden), while eliminating the compulsions (i.e. the weeds).  In short, it is normal for people to have preferences (but…just remember if there is enormous anxiety associated with a preference, then it is probably not a true preference but rather, an OCD demand masquerading as a need).

c Copyright, 2008 Ginger E. Blume, Ph.D.