Living & Arts

Trigger part VIII: dispatches from room 101

In print | April 9, 2009

Disclaimer: This column is part eight of a 10 part series dealing with the author’s experiences with mental illness. As it contains explicit subject matter, sensitive readers may wish to avoid.

I was told, from the day I left the diagnostic ward, that I could not eliminate my unwanted thoughts. Barring the invention of microscopic psychoactive nanobots or something I will have my disorder until I die. (Scientists: it would be great if you could hurry up with the psychoactive nanobots thing. I would very much like to stop being crazy. Also, I really like the image of an army of microscopic Wall-Es marching through my brain and destroying OCD molecules, which would be bright red and have angry frowny faces). I was told this countless times, from a small army of OCD specialists, and yet each time I heard a clinical variation of the teacher’s dialogue from old Charlie Brown cartoons, wa-wa-wa-wa.

Our culture perpetuates the myth of psychiatric treatment as a malevolent conspiracy that eliminates individuality and leaves the patient in a state of idiot narcotic bliss. Forgive me for saying so, but that sounds fantastic. Please, I told my new psychiatrist, bring me some of these evil magic drugs that will turn me into an unfeeling plastic conformist robot, because I have experienced the alternative and if given the choice, I will now take the blue pills over the red ones without hesitation or regret. I begged each professional to electrocute my brain or to saw open my skull and take out the naughty bits, but each time I was denied. Sadly, no amount of psychiatric intervention would transform me into the corporation-controlled joy-robot of my dreams. It was my new therapist, an extremely warm and practical woman, who explained how I could make myself well: through self-administered psychological torture.

Exposure Response Prevention therapy operates on the principle that each obsession is fueled by irrational but genuine terror, triggered by the hyperawareness of the risks and uncertainties of everyday life. To protect ourselves, we construct elaborate, ever-convoluted ritual behaviors: hand-washing to neutralize disease and prayer to stave off damnation, unending silent vigilance to ward off troubling thoughts. But these rituals can never completely eliminate the uncertainty that drives the obsession, and the sufferer becomes increasingly desperate. The only alternative is to face the fear without protective ritual, naked and alone, and to learn to exist despite the terror of complete vulnerability. Eventually, the sufferer habituates to the anxiety and can survive uncertainty without resorting to obsession.

Having been pushed, filed, stamped, indexed, briefed, debriefed and numbered, I was finally admitted to McLean’s hospital’s OCD Institute in late August. The original plan was that I would enroll, overwrite years of painstakingly-constructed maladaptive neurological programming in about ten days, maybe stand sobbing in the rain symbolically baptized, and return to Swarthmore utterly sane in time to purloin a “Welcome Class of 2011” mug from the Alumni Office. It soon became apparent, however, that I required more extensive treatment. I learned I would be unable to return to Swarthmore that fall. Twitching on the hospital’s lawn, I fibbed my way through phone conversations with concerned friends; early on I had panicked and blurted out to a friend that I was taking a semester off for treatment of “stomach problems.” I immediately wished I could retcon my alibi (a friend on the unit recommended “family issues”) but I was determined to keep my flimsy, blatantly-fabricated story consistent. I later realized I had overlooked an obvious, plausible excuse. I should have said that I was spending a semester abroad. Indeed, my situation was roughly analogous, although instead of getting drunk with Australians in Dublin, I was living in a mental asylum and hanging out with my mom a lot.

The OCDI was much homier than the diagnostic ward had been, much like a dormitory with a kitchen and common area. But it was never possible to entirely forget the clinical nature of the facility. The halls were decorated with pictures of supermodels and lengthy strings of random integers, designed to trigger the symptoms of specific residents, and soap and paper towels were distributed on a strict as-needed basis. Occasionally from the bathroom you would hear the sound of running water and then unintelligible screaming. My fellow patients ranged from the apparently normal to those overwhelmed by the disorder, but we were all drawn together by the desperation of our shared circumstances. We played board games and watched the Red Sox through the World Series, we traded stories and dumb inside jokes. The staff at the OCDI was sympathetic and helpful, and a really uncomfortable percentage of them were attractive young women. I am not sure whether to blame this on the malevolent gods of mental illness, taking another opportunity to vex our narrator, or some inexplicable trend of hotness among psychology post-grads interested in anxiety disorders.

In addition to group seminars and a rigidly regimented program of leisurely social activity with other mental patients, the OCDI required four hours of exposure therapy a day. Exposure involves stupid, absurd, unhealthy things that no sane person would otherwise attempt; it was not unusual for me to leave my room and find a middle-aged Hispanic man up to his elbows in biohazardous material. My own exposures were less spectacular. The exercises placed me in circumstances that triggered my unwanted thoughts; I was required to tolerate these situations without attempting to reduce my anxiety by obsessing. I began by recording myself, in emotionless banality-of-evil tones, describing myself committing horrible actions and then listening to the tapes repeatedly. Later I was taken to malls and bookstores, dressed in bizarre clothes, to purchase and publically read highly inappropriate literature. Eventually, I reached a point where I would go to a local coffeehouse and then sit with a cup of tea, the mere presence of other human beings triggering the sickness. I had also decided, in a moment of typical restraint and self-kindness, that I was hellbent on graduating as a member of the class of 2009, and to do so I would enroll in night classes. At Harvard Extension School. While living in a mental hospital. I’d finish a lecture on King Lear and then
wait in Harvard Square for my father to drive me back to the asylum.

I dealt with my predicament in my own way. Although the institute forbade drugs or alcohol, I returned to gratuitous abuse of my personal narcotic of choice; I hesitate to admit this publically, but I have been silent for far too long and I cannot imagine that I am the only one here that wrestles with such urges. I downloaded a Game Boy emulator program and I started to play Pokémon again on my computer. Judge me not, reader. I was desperate and I took solace where I could find it. Someone saved my life tonight: Pikachu.

I did what I was told and I waited to get better. What was eventually determined was that my progress was slow not because of the intensity of my treatment, but the attitude with which I was approaching it. It was, in retrospect, a simple application of my obsessive-compulsive attitudes to a new situation. I was suffering, and I had been told that if I did certain ridiculous things I could stop suffering, so I did these ridiculous things as frequently and as passionlessly as I could and waited for the sanity to return. I was doing therapy as if I were studying for an exam, or as if I were trying to lose consciousness by beating my head against a brick wall. It became clear that I would need to reconcile myself, not only with the content of my obsessions, but also the persistence of obsession itself. It took me a very long time to understand this.

Eventually I accepted that I would never be fully healthy and, paradoxically, I confronted the sickness in doing so. There was no sudden moment of revelation in my treatment, no epiphany. I experienced countless relapses and committed indefensible blunders. I am not healed, and I never will be. I cannot eliminate unwanted thoughts and although I am learning to manage them, I will experience sporadic outbreaks of symptoms for the rest of my life. I will have my disorder until I die. But I am healing, I will continue healing. This is enough. It has to be.

Hamlet is a senior. You can reach him at hamletwrenncroft@gmail.com. The next installment of “Trigger” will be published in two weeks.