Richard Hogan: Living with OCD and intrusive thoughts is a silent hell

Intrusive thoughts can be debilitating. More often than not, they're completely unfounded

The more we fret about an intrusive thought, the more pronounced the thought will become. Picture: Christian Erfurt, Unsplash.

The complexity of the world is almost too much for the human brain to comprehend. Only when something doesn’t work is this elucidated — the heating won’t turn on, the dishwasher isn’t washing, the dashboard is giving a strange reading. These minor inconveniences illuminate just how complex we have made our daily lives. We can’t solve the problems ourselves, but we know who to contact.

But what happens when we face a personal problem in all of this complexity? Well, we often apply a logic that becomes more problematic than the issue we are trying to solve. What I mean is that we often become stuck; doomed to repeat an ever-failing solution. When that solution becomes the problem, things get worse. When the thing we use to make ourselves feel better is the thing that makes us feel worse, we have moved into a familiar dilemma, one that is not so easily corrected.

Let’s just say I’m a pilot, and there is a problem with the plane. The gauges are giving me an incorrect reading about speed — they are telling me that the plane is travelling slower than it is. I haven’t lost altitude — the plane is performing like it had been up until this false reading — so nothing has changed with the flight. But I have a growing fear the plane is going to slow down and drop out of the sky. Everything I know tells me I have to keep the plane moving or it will stall. So, I increase the speed. The faster it moves, the less likely it is to stall (there’s my logic), which makes sense.

Unless, of course, I increase the speed too much: then, overspeed will cause it to stall. The very thing I do to stop it from stalling is the very thing that increases the chances of bringing the feared outcome into reality. This example illustrates the behaviours and thinking we default to when we experience challenging emotions. We utilise an intervention that causes our lives to spiral into chaos.

We have many examples of Obsessive Compulsive Disorder (OCD) in movies. In As Good as it Gets, Jack Nicholson’s portrayal of novelist Melvin Udall, a misanthropic New Yorker who repeatedly washes his hands, and avoids cracks on the sidewalk, won him an Oscar. His daily routine is comically brought to life by Nicholson. But ritualistic behaviour and intrusive thoughts can be far more debilitating and disturbing than the movies show us. They can utterly destroy a life. 

The genesis of the problem is often found in our desire to control. We have to live in so much uncertainty, but our desire to have certainty can so easily become pathological. Of course, biology and genetics play their part in disordered behaviours.

I have worked with many clients who are struggling with what the Diagnostic And Statistical Manual Of Mental Disorders (DSM) would classify as OCD. And it is not a funny experience. Quite the opposite.

One client stands out. He was in his late 20s and living with intrusive thoughts. A beautiful young man with his whole life ahead of him, he was living in silent despair. He had developed the intrusive thought that he might potentially harm someone. This thought was causing him to avoid going out.

His existence had become terrorised by an intrusive thought. His life had shrunk to going to work and going home. He had moved back in with his parents. He didn’t trust himself to be alone. The pain this thought was bringing into his life was absolute.

But the more he avoided, the more it compounded the issue. He was stuck in a positive feedback loop. The more he stayed at home and avoided meeting anyone, the more he believed he needed to stay at home. Like the pilot increasing speed, the more he avoided, the quieter the intrusive thought became, which entrenched the negative response.

Our early work together showed him that this fear of being a danger to society was just an intrusive thought, and just because you think something doesn’t mean that it is true. We often think terrible thoughts that seem jarring and make us worry about how we could think such a thing. The more we worry about the thought, the more pronounced it will become.

His response to this was to avoid people, his logic being that if he were not around people, he couldn’t harm them. He was the most gentle person I have met; he wasn’t a danger to anyone but himself. Some of the work I did with this client was walking around Dublin and proving his logic to be incorrect. As we moved into crowded streets, the voice would become louder and almost despotic.

As we analysed it back in the clinic, he began to view himself differently. He wasn’t a danger, he shouldn’t avoid, and the less he avoided over time, the quieter the inner voice became, until eventually, he got his life back. Living with intrusive thoughts can be a silent hell. We have to be careful of solutions we come to for problems that disrupt our complicated lives.