OCD: What I learned fighting mind cancer

Everywhere you go you always take the weather with you

-Crowded House “Weather With You”.

0. An obsessive compulsive life

Obsessive compulsive disorder is a horrible thing and I would not wish it on anyone. That said, living with OCD has given me a certain way of seeing the world. The insights and viewpoints of that way of seeing are not unique to OCD, but OCD is certainly one path to them. I decided to write this to share what the refining fire of a lifetime with OCD has given me.

  1. Generalities

I’m sorry for the info dump, and if you’re already confident with the basics of OCD, you might skip this section, but it is important to understand the basics for the rest to make sense.

Obsessive compulsive disorder is defined by the presence of one of, or both of, obsessions and compulsions. It is not necessary to have both obsessions and compulsions in order to have OCD– for example, some sufferers either have no compulsions, or very subtle compulsions that only become obvious once the context of the obsessions is understood. By the DSM V an obsession is defined as follows:

1. Recurrent and persistent thoughts, urges, or impulses that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.

2.The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).

And a compulsion is defined as:

1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.

2.The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.

There are a few other parts to the definition, but we can safely leave them aside for our purposes.

2. My specifics

Anyone who doesn’t have a guilty conscience needs one, and anyone who does have one, doesn’t need one.

Something I once read on a Magic the Gathering Card

One more bit of general background- the kind of OCD I suffer from.

I suffer from a form of OCD that makes me afraid of enacting physical, sexual or psychological violence on others, sometimes called “Harm OCD”. I fear both the harm I might do to others, and the consequences I might face as a result of doing such harm. Although this form of OCD is quite widely understood among experts, not many people in the general public are aware of it. Partly I think this is because of the nature of the content of this form of OCD- it’s self-censoring. Although it’s embarrassing, you might be willing to admit that you’re afraid of catching aids in a public bathroom for example. However admitting that you’re afraid of sexually assaulting someone, or kicking a child in the face as you walk down the street, is a more scary proposition. Thus knowledge of this form of OCD doesn’t really seep into the public consciousness.

A lot, but not all of my fears, centre on the following nexus. Within this nexus there are numerous variations on a theme and elaborations, and I am perhaps misrepresenting what is going on in some respects, but this is the basic story. Suppose a random thought of groping someone on the subway pops into your head. At first, so long as you recognise that they are not really your thoughts or desires this thought may not be very frightening. Suppose though that you began to worry that because such thoughts had popped into your head so many times, that you might perform them on auto-pilot- as a kind of mechanical reflex- without even being aware of it, and certainly not intending to. You now have a plausible story about why you should be afraid of these thoughts, and a story about why being afraid of these thoughts is dangerous in itself. So trying to be rid of these thoughts becomes like trying not to think of a pink elephant. You will think these thoughts more because you perceive them as dangerous, and in your mind that makes them even more dangerous.

A simplified schemata of the process:

Thought of harming someone>>>Thought that you’ve had that thought so many times you might do it on autopilot>>>The thought is now perceived as dangerous>>>This makes you want to stop thinking about it>>>This makes you think about doing it more.

Because you’re worried about doing these things ‘automatically’ you don’t even have the comfort of being able to reason ‘well nothing has happened yet and it’s been long time, so it should be okay’. Part of what you’re afraid of is that you might be doing such things all the time, and just not noticing- with the victims perhaps too shocked or scared to say anything.

The irony of harm OCD is that all available evidence suggests that people with it are unusually appalled by violence, and thus much less likely to commit it than the general population. There are no recorded cases of someone with OCD committing violence unintentionally, or in a way in which relates to their fears.

3. The Red Queen Hypothesis of OCD: Fear as genetic algorithim

“Now, here, you see, it takes all the running you can do, to keep in the same place. If you want to get somewhere else, you must run at least twice as fast as that!”

-The Red Queen, Through the Looking Glass

One of the things I find interesting about OCD is the process by which it generates fearful obsessions perfectly targeted against its subjects. In coming to understand this, I realised that OCD is a self-generated mental parasite, operating like a genetic algorithm.

Fearful thoughts are generated randomly, those fears that are successful (in the sense of capturing attention and thus cognitive resources to electorate on them) are selected- just as with a genetic algorithm. These fears give rise to lineages of similar fears and variations on a theme which are in turn elaborated on. Over time, a thoughtful sufferer will come to see holes in their fears, and this leads to arms race where the fears evolve in response to keep up with the growing dialogue between fears and defences, like the red queen theory of evolution in biology, or, like the runaway evolutionary processes of cancer, constantly subverting and being subverted by our natural defences.

Coming to understand that a part of me- my fearful thoughts- was evolving and acting with logic that was blind to, and actually opposed to my own purposes was terrifying, like finding an eldritch horror in your own breast. However, it was also a breakthrough not only in my struggle with OCD, but in my struggle to know myself.

4. You don’t really know scepticism until you’ve fought delusions

You usually learn facts through indirect sources, and you know that these sources can faulty, even if you consider it unlikely. On the other hand the basis of your reasoning about, and inferences from, those facts is immediately present to you. If you don’t find an inference convincing, you will most likely drop it. Thus we have a cognitive blindspot when it comes to being sceptical about our own reasoning- doubting the premises on which we build our inferences is easy, but doubting your own reasoning- the inferences from those premises- is hard, because it wouldn’t be your reasoning if you weren’t already directly convinced it was persuasive in a way in which you are not necessarily directly convinced of the premises you reason on.

Your accepting a sequence of deductive inferences as valid is partly based on your inability to imagine ways it might be wrong. Even in the case of inductive reasoning, your accepting a sequence of inferences as valid is at least based on it being hard to imagine a plausible scenario in which the premises hold but the conclusions don’t. On the other hand, imagining a factual premise false is easy- “I misremembered” or “Maybe someone gave me wrong information”. This asymmetry is a real shame, because as many errors are made through faulty inferences as through faulty premises, so we should be just as sceptical of our reasoning as our premises.

A few concrete examples. Witness the incredulity, confusion and even anger which can arise when someone is corrected about the Monty Hall problem. Another example is the way in which many scientists worry about whether their methodology is generating reliable data, but then scarcely worry at all about whether there are any gaps in their method of statistical analysis.

I believe OCD can help with this- and maybe even if you don’t have OCD reflecting on the experience of an otherwise reasonable person with OCD can shake false confidence in your inferential capacities. Having been in a state where you feel like everything is about to come crashing down on you again and again, only to find each time that your carefully manufactured chains of inferences about what would happen next meant nothing even though you could see nothing wrong with them is very educational. In my experience OCD typically takes a series of commonplace facts and real observations and weaves a story which seems perfectly plausible to the sufferer according to which the only reasonable inference from these facts is upcoming disaster. The inferences involved seem very persuasive, but turn out to be meaningless- so you have to become good at recognising that there is no link between how persuasive it seems to infer D from A, B, & C, and the real validity of that inference.

Recognising that an individual chain of reasoning can always be invalid- no matter how good it looks- is the first step to becoming a hedgehog. More on that later.

5. Epistemic judo- turning doubt in upon itself

“Doubt your doubts…”

-Switchfoot

I began to articulate the idea of epistemic judo. In real Judo, you leverage your opponent’s weight against them. In epistemic judo, the person afflicted with doubt and inconfidence leverages those feelings against their own fears. Empirical evidence suggests that people with OCD are unusually sceptical and doubtful, even about things not related to their fears. Doubt and the trait of being doubtful seems to be intimately related to the aetiology and processes of OCD, leading some to call OCD the disease of doubt. How could the OCD sufferer leverage this capacity to doubt everything against their own fears?

The first step is to think of your mind as a mechanism for generating understandings of the world. Return to our earlier model of OCD as like a genetic algorithm for finding blindspots in your epistemic processes, and using them to trigger fear. You can try to beat it by seeing why every single lie it tells you isn’t plausible after all, and this will help to some extent, but to make progress past a certain point you have to stop believing that just because a fear seems plausible, it is plausible- even if you haven’t got a great counterargument for it yet. If you can’t take this step, your OCD will keep throwing up new fears and variations on the old fears faster than you can spot what is wrong with them. In other words, you have to stop believing that your own OCD driven cognitions are reliable, even if you can’t see the specifics of why they are wrong. You may not have found the logical gap in the argument that you should be afraid of X yet, but eventually you will, and even if you don’t, chances are that it exists.

The strategy to achieve this is to turn the sceptical/doubting mindset OCD generates in, against itself, until you reflexively doubt your fear arguments. To a certain extent, you have to stop believing in your own ability to reason about topics that overlap with your OCD. Ordinary people have trouble engaging in blithe and automatic scepticism of plausible sounding ideas they themselves have generated. However, people with OCD have so much practice questioning and doubting everything, what is it to doubt one more thing? Eventually I turned “I am not qualified to think about these topics well or impartially” into a mantra.

6. Arguing with your feelings

“Thoughts aren’t facts”

-Common Parable

“Feelings aren’t facts”

-Another common parable

Every narrative, every bit of folk wisdom, tells us to trust our feelings- our “intuition”. Perhaps the hardest part of grappling with OCD, and one of the most educational, is learning not to trust your feelings automatically. Sometimes feelings are right and sometimes they are wrong. Just because you feel like SOMETHING IS VERY WRONG doesn’t necessarily mean shit. If you want to overcome OCD, you have to overcome the sense that emotional intuition should never be ignored. You have to be able to challenge your feelings. To put this in a slogan- listen to your feelings but don’t forget to talk back to them as well.

If you think of feelings as unlike thoughts- as beyond debate, let alone volition- as things which ‘just are’ you will find this difficult. Hence you must come to understand the similarities between thoughts and feelings. Both are rooted in ideas about how the world is, and neither are immune from criticism. For example, being “afraid” of a spider is almost always accompanied by the thought that it can hurt your, or crawl all over you in an unpleasant way. There is no sharp distinction between feelings and thoughts.

The wrong way to think about this is to think of it in terms of feelings and emotions being always inferior to formal reasoning- of feelings as inferior or flawed thoughts. Actually, some feelings are very accurate. Sometimes the explicit chains of reasoning we call ‘thinking’ are much worse than the pattern matching we think of as feelings or intuitions, and sometimes the opposite is true. This is unsurprising because, again, emotion was never discontinuous with reason, and both feeling and reasoning are subject to critique, revision and scrutiny.

People have accused me of valorising the Cartesian thinking subject at the expense of the embodied subject of feminist epistemologies yada yada with this view, but I think the opposite is true. Only by challenging the false separation of thought and feeling can we see what is wrong with both the mystical valorisation of intuition and the obnoxious assertion that one has transcended reason for pure rational assessment. “Trust your feelings” and “Suppress your feelings so you can be truly rational” are two sides of the one coin.

7. Becoming a hedgehog: OCD and the struggle against single model thinking

“Homo unius libri timeo”

-St Thomas Aquinas

Almost all OCD type fears have the following structure- a prediction about the future (or in the case of the guilt, the past) based on a specific sequence of events in a causal pattern. This will follow this and then either this or that will happen but then in either case necessarily this must happen… and so on. Even though every individual step might sound plausible, something almost always breaks down, and so the fears of people with OCD are almost never true. This is unitary model thinking is an extreme type of the “Hedgehog” cognitive style identified by Isiah Berlin, and contrasted with the “Fox” cognitive style, based on a more flexible appraisal of different factors and plausibilities. Another name for these modes of thought is Euclidean versus Babylonian methodology.

There’s a great deal of evidence that the hedgehog type approach breaks down not just in OCD, but in things like expert attempts to predict future events. Overall being a hedgehog isn’t a great strategy (although beware anyone who tells you it is always wrong- we wouldn’t want to be meta-hedgehogs).

As I saw how being a hedgehog was making me mentally ill I made an effort to become more of a fox, not just with regards to OCD, but throughout all of my life and activities. For example I tried to view the challenge of predicting the future not as a matter of charting a sequence of events, like falling dominoes or a Rube-Goldberg machine, but instead tallying power factors, tendencies, resources, general drifts of various coalitions and past trends, and throwing in a generous dollop of pattern matching.

8. I am not special: Taking the outside view on yourself

There’s a kind of soft narcissism that OCD forces on you. It doesn’t help that OCD makes you live inside your own head and spend so much time talking to yourself . Your problems seems very distinct from the problems of other people who have your conditions. Their fears sounds so absurd, whereas your own sound so reasonable to you (due to having been specially crafted for your cognitive blindspots).

It can seem like the standard treatments could never help- e.g.: damnit I don’t need to relax, I need to establish that I won’t grope someone! Or: What’s the point in going to a psychologist- I’m just as clever as they are, any point they can make about how my fears are illogical I will have certainly thought of myself! Yet all of this turns out to be false, chances are you’re really not so different from other people, and will benefit from, and be harmed by, roughly the same things as them. Certainly that was my experience.

Recognising that you have all the fallibility — and strength- of other people is incredibly liberating. It’s okay to reason as follows:

“Hey, this stuff seems plausible to me, but I am literally a delusional person, so rather than using what the base odds seem to me to be, I should think about it from an outside point of view. How many people with OCD feel their OCD fears are plausible (almost all), and how many actually turn out to be right (almost none, and literally none in cases of harm OCD like you have). Therefore it’s massively unlikely that you will be the first person with harm OCD ever to have your fears realised. The fact that you think you are an exception to this rule, doesn’t matter a damn, because there is a 100% chance you would think this, given your OCD.”

In other words, it’s okay to take the outside view on yourself.

This isn’t just about the plausiability of your fear arguments. You have to take the outside view on a lot lifestyle and treatment factors, like “While it seems that my problem is the dangerous situation I’m in, so sleep won’t help, if I actually get some rest, the experience of countless humans over many millennia indicates the situation will probably seem very different”. Or “While I don’t feel consciously lonely, and socialising doesn’t feel like a priority since I believe my life is about to collapse, the experience of the human race as a whole would suggest it’s a bad thing that I haven’t talked to anyone except my parents in almost three days and that this, not my situation may be the real reason for my terror, so I need to go meet up with a friend”.

I’ve taken this attitude and applied it to other areas of my life. I don’t regard my studies and writings as attempts to find truth in any personal capacity because the odds that I will discover something important are much lower than the odds that my novel ideas are just crankery. Instead my hope is that I will contribute to the social process of truth seeking. I look upon my own work indulgently- from the outside perspective it is true that my work is likely air and puffery, but also from the outside perspective it’s true that you could say that of just about anyone so it is important that we don’t let the fact that our work will almost certainly be either wrong or unoriginal stop us.

9. OCD and non-self

“I may venture to affirm of the rest of mankind, that they are nothing but a bundle or collection of different perceptions, which succeed each other with an inconceivable rapidity, and are in a perpetual flux and movement.”

-David Hume

It’s kind of pat, but it’s got to be said. At a certain point, gazing at the changes within yourself, and understanding them as intertwining and sometimes contending forces you begin to see the inside of your own brain not so much as a monarchy with an ego-king, but as a republic, full of traitors, excitable mobs and hard working but beleaguered bureaucrats. Seeing yourself as a balance of forces can inspire vertigo, but it can also inspire hope. A unitary subject with attributes attached is hard to change, a contending swarm can shift.

I remember vividly sitting in a lecture when I was much younger, shaking with terror that I could barely conceal. I began to imagine myself as like a boat on a stormy sea, except because I was both the boat and the sea I could never escape. Wherever I went I would always take the weather with me. As painful as this moment was, it stayed with me because it was the beginning of insight.

Later, I beheld the mirror and saw nothing reflected there, and so realised that “I” wasn’t beholding the mirror at all, I was the mirror, I was the room in front of it, and I was the wall it stood on. There is no person in that room, and there could be no person in it, because that room is a series of components which make a person.

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