Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Perfectionism, Harm OCD, Suicidal OCD

The fear of failure

By Dylan AP Davis

Have you ever seen the show, One Thousand Ways to Die? It ran on Spike TV from 2008 to 2012 and featured heavily dramatized depictions of “real” deaths. It was quite popular with my demographic at the time – middle school and high school-aged boys. More than one conversation at the lunch table kicked off with “Did you guys see the dude who died from X?!”, where X might be “getting decapitated while leaning out of a moving car”, or “falling out of his office when his shatterproof window popped off its frame”, or even “being hit by a bullet somebody shot in the air a mile away.” I, of course, watched the show to make sure I fit in, but boy did it give me some nightmares. The show framed nearly every death as being, directly or indirectly, the fault of the victim. One way or another, they had “caused” their death and even potentially “deserved” it.

Every dream for weeks was a rerun of those episodes, except with me at the center. I was the idiot who lit himself on fire with a can of body spray, or the guy who fell down his chimney in a Santa costume, or the one who died performing Do-It-Yourself liposuction in his garage. By night I was dying in droves, and by day I was doing everything I could to avoid my fate. Looking both ways before crossing the road. Standing far from any ledges. Locking the door when I was alone. “Don’t smoke in bed,” I’d remind myself, though I had never touched a cigarette.

Always a nervous child

This behavior wasn’t entirely new, as I had always been a nervous child. I was terrified of being hurt, of getting lost, of losing others, and most of all being wrong. School, was an endless race to get as far away from that fearful “F” as I could manage. One time in seventh grade, we spent an entire term on poetry. I wanted nothing to do with writing poetry, as it was far too ambiguous about what a “good” or “bad” poem was. Essays I could handle, as I generally just had to write about something factual. There were sources I could confirm, and facts I could check! No such thing existed for poetry, as far as I knew. I struggled hard, and my fear of being judged for my poor creativity led me to not try as hard as I could. My grade for the term was somewhere in the C range. For the first time in my life, I hid my report card. I was terrified about what my mother might do when she found out. So, I hid it. She found it. Things were unpleasant. I did not get a grade that low again.

The storm

Years later, I was home for the summer between my freshman and sophomore years at college. I was about to do something, and I was terrified about what my mother might do when she found out. There was one major difference though: this time I was the one confronting her. I knew what she had been hiding, and the truth was going to come out. Things were unpleasant. As a family, we went to therapy. It wasn’t productive, though the therapist truly did her best. She told me I was great at compartmentalizing. I filed that idea away for later.

Luckily, I could stay at my sister’s until school started up again, where I could live in my dorm. I doubled down on school and was able to isolate myself from the storm for a few months. On Thanksgiving break, we had dinner which was more uncomfortable than any I could have imagined. It was the last time I saw her. She hunted me for a while. One time I had to hide in the networks lab until late, as I got word that she was driving around my campus looking for me. The walk back to my dorm was tense. I didn’t sleep that night, consumed by worry, fearful of what might happen. 

Looking back at it, I can’t quite say when The Thoughts started. Perhaps they started that night, or perhaps they were always there. What I do know is that The Thoughts started to get much, much worse while I was in grad school. I was able to distract myself with research and coursework, with my job hunt, with videogames, with friends, with anything I could find, but still, The Thoughts persisted. Years of my life had been spent in nonstop pursuit of higher education, of achievement, of pieces of paper that said I was worth something. I got a job, I fit in relatively well, and I even bought a home with my husband. Everything was looking up. So why was I becoming increasingly convinced that my life was going to come crashing down?

Over and over, creeping towards me as the years passed, The Thoughts began to play in my head. You’re not good enough. You’re going to mess this up. You’re going to forget something important. You’re going to crash and burn at this presentation. You’re going to say something offensive to somebody. You’re going to get yourself hurt. You’re going to make yourself lose everyone. You’re going to trip and knock your teeth out. You’re going to miss the cancer growing inside you. You’re going to hit your head, develop a concussion, ignore it for too long, and die from a brain bleed. You’re going to cut yourself by accident. You’re going to crash and burn while driving your car. You’re going to get yourself shot. You’re going to fall off that ledge. You’re going to climb over that ledge and throw yourself off. You’re going to cut your wrists open and watch your life end. You’re going to ruin everything and everyone you love, forever.

Trying to drink away the suffering

I began to drink a lot. Anything to make The Thoughts stop. Anything. It worked, a little, for a while. One weekend, while I was still in grad school, my husband went away for a work conference. I began to drink. More and more of The Thoughts. More and more drinks. It had to end. It had to end. It had to end.

My hand gripped my apartment building’s handle. The outside handle. Why was I here? Wasn’t I just in my apartment? Why was it so cold? The door was locked, and it was dark out. I walked around, tried the other door, and failed to open it. I walked some more and sat down near a tree. What time was it? What was I doing out here? Where were my clothes?

It hit me all at once. The life I knew was over. I was locked out of my building, disoriented in the middle of a freezing winter night, with nothing to protect me from the cold. Nobody knew I was there, nobody was coming, and if anyone did happen to find me before I froze to death, I was certain they would call the police. After all, given my current state I was nearly indistinguishable from the archetypical crazy person, someone so clearly out of their mind that they might even be dangerous to approach. I had heard stories about people in similar situations, and nearly all of them ended with criminal charges at best or dying on the street at worst.

As The Thoughts had gotten worse, I had begun to watch video after video and read article after article, about people ruining their own lives. Mistaken judgment in a heated moment, a mistimed leap of faith, or choosing to take a drug that caused them to act out of character. Every step they had taken had brought them to that LiveLeak video, to that mug shot, to that graveyard plot. They left confusion, pain, and misery in their wake. Their entire lives, capstoned by a horrific moment in the Internet’s proverbial sun, witnessed by thousands, forever engraved in bytes and hyperlinks.

There I was, at my own capstone. This was how it was going to end – whether I survived the night, my life would surely be irrevocably changed. My family would be burying me soon, my husband would be left widowed by a man who did himself in. Or maybe instead I would now have a record. I would be unemployable, a wretch, a cretin spat on by citizens of good standing. An offender, undeserving of love. Just the start of a spiral toward my inevitable demise – one that somehow seemed even worse than a physical death that night. The death of my reputation.

My life did not end that night. Someone did see me, and they did call the police. They did not kill me or arrest me. For whatever reasons they had – perhaps it was in their training, or it was privilege due to the way I looked, or they had sympathy for people in my situation, or maybe it was simply luck – they recognized that I was someone in need of help and shelter instead of a taser charge and a court date. They put me in a holding cell for the night and drove me back in the morning. My landlord let me in, shared some of her own struggles in a noble attempt to make me feel better, and left me to tend to the mess I made.

This is the part where you might think I had learned a lesson, that maybe I now recognized that I had a problem and got the help I needed. You’d be quite reasonable to think that – after all, hasn’t that been the point of everything you’ve read this far? I’m sorry to disappoint you. Rather than holistically looking at what went wrong, questioning my assumptions, and paving a path forward for myself, I instead did the one thing I most excelled at. I compartmentalized. I put the episode behind me and filed it away in a box to never look at it again. Clearly, I had just drunk too much. That was it. Just a drunken accident that I was lucky to get through no worse for wear. Nothing more.

What if I ruin my life?

The Thoughts only got worse. Every day, I was thinking of ways that I would ruin myself. I consumed every piece of media I could find about people ruining their own lives. Working backward from their moment of failure, I put together their paths the best I could. What led them there? What went wrong? What could I do to prevent the same from happening to me? I never found an answer that would satisfy what was living in my head.

Years passed, and it only got worse. Every waking moment was tainted by The Thoughts, every quiet walk with my husband a screaming cacophony of prophetic doomsaying careening about my head. Nothing made it better – not work, not spending time with friends, not gaming, not reading self-help guides, not having a positive attitude, not keeping my head up, and certainly not alcohol.

One day, I had a breakdown while driving to work. A sickening idea had entered my brain. I thought that I would pull over, throw open my door, and run into traffic. “Like a crazy person.” My hands had begun to turn the wheel before I caught myself. I called my husband while choking back tears. Somehow, I drove home. I told him the truth, about some of the things going through my head.

So began the calls. Eventually, I ended up with an appointment with a therapist in my area. During that first appointment, I decided I had nothing to gain by withholding the truth, so I told him all of it. Every imagined destruction by my own hand. My inability to explain why I spent so much time imagining it. How The Thoughts told me that I was at every moment just a step away from bringing my life to ruin.

He told me the truth right back – I quite likely had Obsessive Compulsive Disorder (OCD). Like many people, I had preconceived notions about OCD that did not remotely align with my situation, likely originating from popular culture depictions of the illness in shows like Monk or Scrubs. I wasn’t exceptionally neat, nor did I care too much about things being perfectly organized. Turns out that isn’t even remotely a requirement for OCD! 

I knew, logically, that The Thoughts made no sense – I had no desire to hurt myself, and the outcome of acting out those thoughts sounded awful! Why would I possibly want to do that to myself? I would try to combat them with reason, distractions, with research to help me avoid making the mistakes of others, but it simply would not work. They persisted and caused me terrible agony. Why was I thinking about hurting myself? Is that what I really wanted? If it wasn’t, why did I keep thinking about it? What was wrong with me?

The beginning of recovery

Everything began to click into place. Over the next year and a half, I met with my therapist weekly. I was able to get a psychiatrist who I worked with to find the medication that could stabilize me while I worked through therapy, which was by no means easy. I had bad reactions to several of the medications we tried, which would force us to try something else. Over the course of my treatment, at different periods, I have been prescribed the following medications: Fluoxetine, Venlafaxine, Sertraline, Lamotrigine, Abilify, Trileptal, Klonopin (Clonazepam), Vistaril (Hydroxyzine), Lithium Carbonate, Anafranil (Clomipramine). 

I finally hit a steady state with a combination of Lithium and Anafranil. I had some side effects that genuinely sucked but were manageable and far less bad than what I was going through when I was unstable. All the while, I talked with my therapist about all the things I had filed away, opening the boxes together step by step. My mother was often the star of the show, of course. By then it had been several years since I had last seen her, and I had processed exactly none of the trauma. These were brutal conversations to have, and my therapist challenged me every step of the way to not turn away from the pain. Perhaps the hardest part was accepting that I could not have saved her from herself. At the end of the day, she made the choices she made and hurt the people she hurt, and that was that. I dealt with much more than I had thought I was capable of, and my mood did generally improve.

What did not improve nearly as much were The Thoughts. Images of my own demise and ruin would assail me, and I would do whatever I could to hold them off. At times when I was alone, I would block off the front door, so that I could not run outside and hurt myself. Some days, the terrible possibilities of the knife drawer would keep me out of the kitchen. There was one particularly bad day, while I was adjusting to a new medication when I felt reckless. I was sick of The Thoughts and wanted them to stop. So, I listened to them, hoping that would satisfy their demands. They told me that I would empty out all my pills into my hand. I did.

During one of my many searches for ways people had ruined their lives, I read about the lethal dosages for various medications in the past to be sure I would never take that much. The Thoughts knew how much I would have to take to end it. I didn’t want to, but they were in my hand all the same. I stared at them for some time. 

Eventually, I put them back in the bottle, went up to the attic with my laptop (this was during the height of COVID), and met with my psychiatrist for a regularly scheduled appointment. I told her what happened. That information, combined with my understandably poor mood, drove her to give me an ultimatum: either I brought my husband up there so they could speak, before he drove me to the emergency room for an involuntary hold, or she would call the authorities and send an ambulance to my house to drive me there anyways. Seeing no other choice, I went down and grabbed my husband. After speaking with her briefly, he drove me to the hospital.

Being hospitalized

As the hours there passed, a sense of indignant frustration grew over me. I was put in a bed, had my possessions taken away until I was left only with a gown and my underwear, and had to accept that a hospital employee would be spending the next twenty hours or so staring at me to ensure I did not hurt myself. They didn’t even leave me the flimsy plastic trash barrel.

Not a single person believed me when I said I didn’t want to kill myself. By the time I saw a mental health professional at the hospital, around 3 AM if I recall correctly, I was at my wit’s end. As she interviewed me, asking me why I was there, to gauge my mental state, I made a horrendous case for myself. She felt it was unsafe for me to go home, despite my frequent protests that I had to be back so I could work in the morning, and ordered that I be placed somewhere for further examination. My husband took on the task of informing my manager at work that I’d be out, which eased my worries slightly.

Hours passed before they could find a spot open for me, during which I felt only worse due to the guilt of taking up a hospital bed during the height of the COVID pandemic. There was no reason I had to be there! It made me feel like nothing but a drain on society. Eventually, yet another ambulance came to grab me and drove me to my destination. Luckily, surgery on my knee earlier that year had already caused me to hit the minimums I needed to get my insurance to cover most of the costs. The last thing I needed at that point in my life was yet another massive medical bill, and for once the Health Insurance Overlords saw fit to grant me a reprieve.

Once I was let off the stretcher (I was not allowed to walk into the building, they wheeled me in), I was shepherded into a side room by an exceptionally nice woman and an assistant. I had to remove my underwear while standing behind a large blanket she held up to ensure I wasn’t smuggling in anything. That was honestly not as bad as I expected – they were quite polite and seemed more embarrassed about the situation than I was.

Clothed again, I was brought to a room with a desktop computer set up, on which was a staff psychiatrist with whom I met remotely. He offered me a choice. I could voluntarily accept that I was to be held there for as long as they deemed necessary, or I could contest my detention here and claim I was being held involuntarily. If I contested, it would trigger a legal process that would produce far more of a public record than if I chose to stay.

Fear gripped me, one of the world finding out that I had failed so terribly that I had to be held in a mental institution. Everything that I had internalized from my mother – who viewed mental health treatment as a grand adversary or even a conspiracy – came to the surface. Schemes whirled through my head, insane speculation on how I could weasel my way out of this, but the psychiatrist assured me that I had no other option. It was A or B. He let me leave briefly to speak with my husband on the phone.

Taking his advice, I decided to stay voluntarily – my fear of others finding out what happened outweighed my belief that I didn’t belong there. In retrospect, this was one of the best choices I have ever made, but not for the reason I expected. Once I had made the decision to accept help, even if it was for the wrong reasons, I found it easier and easier to make the decision again. I told the truth about what I had felt, about the thoughts I had, about who I really thought I was.

At one point, they handed me an informational handout with information about OCD. I had never actually looked up the condition, even after I had mostly accepted my therapist’s diagnosis, and it was a shock to see my daily experience laid out in bullet points. There was something wrong with me, but it wasn’t some shameful reflection of my poor character. It was an actual illness, one with common traits that were by no means unique to me. OCD was no longer an ineffable curse, but something that could be cataloged and described, even treated. I could get better.

My time institutionalized ended up being brief, as I completely cooperated with everyone and agreed to a safety plan regarding the medication bottles that my husband could monitor. I met some incredible people there, both fellow patients and staff. My roommate and I spoke for hours. The food ranged from actually kind of alright, to bland, and to outright terrible. I eagerly took in the brief time we were allowed outside in a little courtyard, looking out at the traffic passing off in the distance. Daily blood draws, to check my lithium levels as they upped my dose, was not so great. Always hated needles.

What was great was my disconnection from technology; though we were offered “phone time” to use our smartphones that they held in a separate room, I chose to use this as an opportunity for a detox of sorts. I’m one of many who would be found guilty of Doomscrolling from time to time, so the break was quite nice. My husband brought me a book to read. It was our wedding anniversary that weekend, so I spent a while writing him a card to give to him when I got out.

On day three, after one last meeting with my entire care team and my husband, I was set free. My voluntary/involuntary hold was a turning point. I had had enough of hiding my condition, from myself and from others. Very few people knew me aside from the mental health professionals I had interacted with. I called each of my siblings. They took it better than I expected. Afterward, while looking up something related to my treatment, I discovered that the upcoming week was, improbably, OCD Awareness Week. Stunned, I took it as an opportunity. I hopped on social media and told all of my close friends about my diagnosis and what had happened to me. Everyone responded with nothing but love and support.

Finally getting ERP

This led me further. Though I experienced trepidation about doing so, I told my team at work the truth when explaining why I had suddenly gone absent partway through the week. Nothing but kind responses there as well. I was shocked. Everything I had heard about mental illness had cast it as something terrible, a shame that you should never let others discover lest they cast you out in response. I had internalized so many terrible ideas about myself, about mental health, about how people treated others, that I had never even conceived of people treating someone like me with kindness and understanding.

With that, I began walking down the road to a better place. There were still plenty of ups and downs, but progress was happening. My psychiatrist mentioned to me that another one of her patients with OCD had experienced great success improving their symptoms with the help of an organization called NOCD. My insurance even covered it! I figured I’d give it a shot.

Working with one of their therapists, I practiced Exposure and Response Prevention, which taught me strategies for actually managing The Thoughts. For whatever reason – I believe that nobody quite knows what starts the process – the brain can end up being metaphorically programmed into having OCD. With that condition, intrusive thoughts will grow ever more persistent in response to your attempts to soothe the anxiety they cause. When you reassure yourself that the bad things you’re thinking about won’t happen, your brain’s errant program responds by queueing up another thought to hit you with.

The key to reducing the power of these thoughts is not to run away from them, not to push them away, and not even to challenge them. It turns out that the most effective way we’ve found to deal with it so far is to simply sit with The Thoughts, and let them say their piece. Almost as if you were dealing with a child having a little temper tantrum, you just let all of the terrible, anxiety-inducing thoughts rage as they will, until they tire themselves out.

While under guided supervision, you are exposed to a situation that triggers intrusive thoughts, and throughout you must self-assess your anxiety levels. What are you feeling as your brain presents upsetting ideas to you? Be honest with yourself, and track how you feel as you continue. Eventually, though it may take quite a while, you’ll notice the anxiety will start to decrease. A quiet observation of the situation will lead you to a calmer state. Give no response except for acknowledgment of what you are going through. You, in a sense, build up a tolerance to the anxiety The Thoughts provoke. Eventually, they become nothing more than what they always truly were, even if they had once felt like something so much worse.

Just thoughts. That’s it. That’s all they are. Just because you had a thought, doesn’t mean you have to act on it! We can’t really control the occasional nonsense our brain spits at us – intrusive thoughts that feel random or seem to come from nowhere happen to nearly everybody at some point in their lives – and it genuinely has no bearing on your moral character or what you will choose to do. My brain’s constant assurances that I would destroy myself really meant nothing in the face of the reality that I simply did not want to

With the guidance of my therapist trained in ERP, I did exercise after exercise and learned to sit with the anxiety and uncertainty my thoughts caused. At one point, she stayed on a call with me as I drove to a parking garage under her direction. Once I had promised her that I truly had no intention of hurting myself, she had me head up to the roof, and simply stand near the ledge, which was so high it came up nearly to my chin. There was no possible way I could fall off accidentally, and I did not want to throw myself over the edge, so I was in no physical danger.

Thoughts of throwing myself over, of course, emerged from the nether. I let them. Getting up on my tiptoes, I stared over the edge. It would really hurt if I jumped. Probably would kill me. I always could do it, the possibility would always be there, but I simply did not want to. Best not to do that. Thoughts stormed, but in the end, that’s all they could do. After a while, I stepped back, thanked my therapist, got in my car, and drove home.

I’m not claiming it was a miracle cure. The thoughts weren’t left slain in the dust as I drove off toward the sunset. Every day they would show up, the specter of uncertainty knocking on my front door to sell me prophecies of my doom, and I would let them talk until they got tired and left. Leaving was the new part. There were actually times when I could just… think. On my own, without some harmful nonsense filling up the space. My life got tremendously more stable – enough so that I was able to dial down my medication under my psychiatrist’s supervision.

All that time to think gave me an opportunity to move forward. Eventually, over a couple of years, I came to several conclusions about myself and my life that helped me find a good deal of peace. All those lessons that I’ve mentioned throughout this post. The peace of mind helped me to actually accept them emotionally, not just know them logically.

My life had been consumed by efforts to keep failure far away from me, and it caught me all the same. I failed to recognize my own problems for what they were, I failed to deal with what had happened to me when I was younger, and most of all I failed at being honest with myself and those I loved. Those failures led me outside that one Winter night, and they led me to where I am today. It was only in acknowledging my failings, and accepting the role I had played in perpetuating them, that I was able to move forward and begin to make things right.

I’ve overcome many problems, and I hope to do the same with many more. My life, for now at least, has become remarkably calm. I can sit, and there’s quiet. I have the space to feel joy, genuine joy, at the good things in my life. Things will never be perfect, and I don’t expect them to be. I know there will be times when I fail to measure up, where I will make poor choices and face consequences that I should have seen coming, but I also know now that letting myself be consumed by the constant fear of failure would be a bigger mistake than any I could imagine. To err is human, after all. 

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