On OCD and Poetry
Thanks to Holly Magill and Claire Walker for publishing my poem Reckoning on Atrium today. The poem is from my forthcoming collection, The Sessions, which draws on my current work as a clinical psychologist as well as past experiences of mental health difficulties and therapy. For this blog post, I thought I’d offer some reflections on my encounters – personally and professionally – with obsessive-compulsive disorder (OCD), and the meeting ground between poetry and therapy.
There are lots of excellent sources of information available online nowadays which I wouldn’t want (and couldn’t hope) to replicate (see links below). One thing I did just want to highlight is the idea – at the heart of the cognitive model of OCD developed by Professor Paul Salkovskis and colleagues – that the kinds of troublesome intrusive thoughts people with OCD are prone to (the “obsessions” of OCD) are not, in themselves, rare, unusual or even problematic. The problem, so the theory goes, is the way in which these thoughts are appraised and responded to. Let me explain.
Intrusive thoughts, first of all, are basically just thoughts (or images or urges) that pop into our minds without us consciously reaching for them. We get them all the time – our minds are constantly whirring away, processing the myriad unfolding facets of experience. And there’s a lot that’s good about this: after all, isn’t the capacity to wander in our thoughts, to follow the twists and turns of imagination, an essential part of creativity? Some intrusive thoughts may be less desirable. Our minds are excellent at bombarding us with all manner of worries, questions, images and doubts (did I actually turn the hob off this morning? what if I caused an accident back there? imagine if I did xyz horrific thing… ). But – here’s the thing – it’s only what we make of these thoughts that determines their desirability. If you’re a crime writer, an intrusive thought about a gruesome murder might (conceivably!) be a welcome source of inspiration. If, however, you are someone who sees a thought like this as wrong or dangerous in some way, then it might be much more bothersome.
For people with OCD, intrusive thoughts are appraised in a way that renders them significant (I really need to listen to this thought), often personally meaningful (what does it say about me that I’m thinking this?) and a call to action (I must do something about this). So, thoughts that would typically be shrugged off by someone else become laden with fear and responsibility. The task then, in therapy for OCD, is to help people relate differently to obsessive thoughts, to recognise that they are not ‘fucked-up’ at all but just an ordinary part of how our brains work and no more worth our time and attention than spam emails (this analogy is courtesy of Dr Blake Stobie – check out this excellent Ted Talk here for more on the psychology of intrusive thoughts).
For me, growing up, there were lots of thoughts about inadvertently causing harm which led me to carry out all sorts of compulsions – checking, washing, monitoring. The compulsive response is totally understandable of course, but – and here’s the really sad thing about OCD – every time I responded to these thoughts, I inadvertently reinforced the idea that this was the way to handle these thoughts and that they needed to be handled. And in doing so, I tagged them in my mind (and brain) as important signals of danger, making me more and more vigilant to them and ready to respond again when they popped back. And part of me could see myself going into overdrive. But this isn’t just a cognitive thing – when you’ve spent so long living, in imagination, with the possibility of causing horrific harm or transgressing in some horribly shameful way, you do whatever you can to make those thoughts and feelings go away. You find reassurance, you scrutinise yourself, you check.
A key part of cognitive-behavioural therapy (CBT) for OCD is learning to respond differently to intrusive thoughts by, essentially, not responding to them. In therapy lingo this is called “exposure and response prevention” (ERP) and it basically involves gradually and systematically moving towards the situations that trigger anxious intrusive thoughts and doing, well, nothing. Not checking, or cleaning, or correcting, or neutralising, or whatever your particular set of compulsions are. For me, some of the particularly pernicious compulsions were not the more obvious behavioural ones but a bunch of internal rules that had me constantly policing my thoughts and actions in particular domains and engaging in a kind of elaborate self-interrogation. Learning to dismantle this infrastructure of thought was a long and tricky business, and I won’t pretend that I don’t find myself walking those old mental pathways occasionally, but there are other routes now, other perspectives.
Lots of things helped, including therapy, and medication. I've also been blessed to have incredibly supportive family and friends. I also think poetry has helped, in ways that are a bit hard to pin down. It’s not that I’ve written about OCD specifically (this is actually the first time I’ve written anything about it) but something about the practice of writing and the space it opens up feels important. Maybe there’s something about a poem’s resistance to certainty that offers an antidote to OCD’s stubborn, inflexible rule-book. OCD hankers after the indisputable; it feeds off uncertainty, and where there is room for doubt it muscles in, demanding answers. For me, poetry offers a different relationship with uncertainty: there’s no “right or wrong” when it comes to reading and interpreting a poem, and often a poem contains multiple, sometimes conflicting, feelings and perspectives. Similarly, in writing, I’m often occupying a place of uncertainty, feeling my way, open to being surprised and challenged. There is a relinquishing of control that comes with writing, a kind of leap of faith – perhaps a little like stepping away from the orders and imperatives of a compulsion (as in ERP). At the same time, there’s also a feeling of agency in crafting something, in the idea that through a poem one might stumble towards something truthful – not in the OCD sense of solid and certain – but something less clear; a wilder and un-pin-downable kind of truth.
In my first blog post I talked about the idea of poetry as being a fundamentally compassionate business. I don’t mean in a pampering, wallowing kind of way (self-compassion can have these connotations sometimes) but in the sense of being receptive to emotional suffering in all its manifest and managed varieties. One of the hard things about OCD can be the tremendous dissonance it creates: feeling both resistant to (and sometimes embarrassed by) one’s obsessions and compulsions but at the same time utterly in their grip. Much like therapy, a poem offers a space in which to speak from – or perhaps listen to – the different parts of oneself. To acknowledge that we can feel at once “competent” and “reckless”, how we can pull the rug out from under our own feet – and how it’s tough to be in conflict like this.
The internal “voice” of OCD (I mean this in a metaphorical sense) can become loud, threatening and punitive . Underneath this though is a more vulnerable realm of feeling – uncertain, fearful – which has its wellspring in those dizzying questions we all wrestle with about who we are and how to be. What does it mean to be good, to do harm? How am I seen in the minds of others? How do I handle the responsibility of choice? Poetry invites us to turn towards the vertiginous edges of fear and, in doing so, to recognise its burden and its inevitability. For me, I think part of recovering was developing a kinder relationship with OCD, and with the feelings of uncertainty and insecurity that accompany it. Don’t get me wrong, there’ve been plenty of times when I’ve felt utterly exasperated and exhausted with it. But if we can step back from the conveyer-belt of daily worries – whether the bossy demands of OCD or, indeed, other forms of anxiety – and recognise the all-too-human fears bubbling away at their core, then we might just feel a little less alone.
Reckoning is a (loose, unrhymed) sonnet – one of 50 that make up my forthcoming collection. I think of those 14 lines as being a bit like the boundaries and time-limits of a therapeutic session: a kind of container. Maybe there was something about this idea of limits that attracted me to working with a set form – a reminder that we rely on structures (and brains!) that both support and restrict us. Often, OCD comes with a whole bunch of unobtainable self-imposed expectations as people seek never to put a foot wrong. Just as the therapy hour is limited, so too is the poem, and so too are we. There’s only so much we can do, only so much we can say or know – and we do our best with what we’ve got.
Links and Resources
Salkovskis, P. M., Forrester, E., & Richards, C. (1998). Cognitive–behavioural approach to understanding obsessional thinking. The British Journal of Psychiatry, 173(S35), 53-63.