My Obsessions Return

It was on a sunny October afternoon in 2005 when an old nemesis reappeared after a ten-year hiatus. I started obsessing again, and while my anxiety has abated greatly over the last year, it still can be a problem. This unwelcome visitation has required me to reassess many of my assumptions about myself and adopt a rather dramatic new approach to life—not something I had anticipated doing at this age. used to think that writing about yourself and your problems could be seen as self-indulgent. It is only in recent years that I have come to believe that it’s important for me to acknowledge as openly as I can the painful things about my life with as little shame as possible. This is the way I am, even though I might wish otherwise. Life at this stage is all about accepting yourself as you are, as you have been, and as you will be; or, at some undefined time in the not too distant future, will not be.

I have generally been a sort of two-sided person psychologically—one side with quite low esteem and feelings of shame and isolation, especially during periods of obsession; another side that had a rather good view of my abilities and myself in general and that leaned heavily on a fantasy that I had potential to do any number of disparate things well, given world enough and time. The two opposing views have been in contention for a long time, but the positive side, fortunately, has been much more often dominant. Over the years I have been able to get things done, marry a wonderful woman, raise a family, make good friends, hold a challenging, satisfying job, and have a pretty good time out of life.

I had charged happily into retirement in 1996. I was finally going to have time to do the things I had always wanted to do—the chance at last to delve into my potential. I took lessons from a couple of different jazz players and played the tenor sax and clarinet regularly at the Colonial Inn in Concord and with other groups. My playing got much better. I took photography courses and an ongoing opera seminar at Pine Manor College. I volunteered at the Obsessive Compulsive Disorder Clinic at McLean’s Hospital twice a week, helping coach patients through their behavioral therapy treatments. My wife and I traveled a great deal.

And I was fortunate to become a member at HILR in 1997, enjoying the incredibly wide range of courses that miraculously seem to emerge from our varied membership. I was particularly intrigued with the science offerings since my background was deficient; by now, I must have taken upwards of 40 courses ranging from the physics of sound and Benjamin Britten’s operas to Shakespeare’s sonnets and Buddhism. Most exciting of all, a first for me, I made a beginning at writing poetry with the help of Fran Vaughan and then started writing fiction in Paul Pemsler’s excellent group, which I have continued to do. Some of my efforts have been published in the HILR Literary Review.

In many ways these years were the calmest and happiest of my life. Well, idylls come to an end. I had given thoughts of my mortality and aging very little time. I had excellent health and immodestly assumed I would be able to continue my program of self-improvement until well into my nineties. But the physical picture began to darken a bit when I turned 70. I developed some shoulder problems and had to give up golf, which was just as well because my game wasn’t progressing as anticipated. Then I started hobbling around with arthritis, and in the summer of 2005 at age 72, I got a new right hip. My physical horizons were being gradually being pulled in. I also think that the two opposing sides that I had managed to keep apart for so long were now ready to crash together like tectonic plates.

So as I was starting to confront the existential issues of deteriorating physical and mental abilities and capacity, loss, old age, and death, I suddenly dropped into the abyss once again.

Obsessive compulsive disorder (OCD) is a condition where people have persistent tormenting thoughts that they fervently want to stop and can’t. The capacity to obsess is largely inherited. Efforts to curb the thoughts through will power or by utilizing certain thoughts and actions to counter the obsession simply make it worse because while they may provide temporary relief, they actually reinforce the obsession’s presence and power. It’s not possible to stop thinking about something you’re trying not to think about.

The terrifying thought is the obsession. The various steps that people use unsuccessfully to rein in the thought (some of them almost magical in nature) are the compulsions, also called rituals. Obsessions seem to come from nowhere and can range over a wide variety of areas—postpartum mothers concerned about stabbing their newborn child, a religious person thinking with horror of blaspheming God or wishing to have sexual relations with Jesus, fears about contaminating oneself or others that can lead to endless hours of showering and hand washing, inability to throw a scrap of paper away for fear it will be something of life or death importance, thoughts about perverse sexual practices—these are just a few of the tormenting, bizarre sounding thoughts that go through the head of a person with OCD. Over a period of time, obsessions can be crippling for many. One in 40 people supposedly has some degree of obsessive thinking and studies have shown that normal people have on occasion the same kind of thoughts as those with OCD, but luckily they don’t stick.

My first real obsessive experience was at age 20, when I suddenly began to focus on my mouth and the process of talking. I became preoccupied with the idea that if I couldn’t stop this, I would eventually not be able to speak. This made for an unpleasant few months. I became panicked and anxious, but thought it was so weird and shameful that I couldn’t tell anybody. This just fueled the anxiety. I did keep on talking somehow, but kept anticipating the moment when I would completely freeze up.

At Christmas time, our family doctor referred me to a psychiatrist. I told him my story, and rather than throw me out of his office, he sympathized and said we could work on the problem and figure out why I was thinking that way. Somehow, in a few sessions, he convinced me to go back to school in time to take my exams, and within a couple of months that particular obsession had thankfully gone away. The talking cure had worked. I should note that psychotherapy was once thought of as the treatment of choice for OCD. In fact it was the only treatment. But those with obsessions who work in therapy may uncover deep, painful truths about their childhood and yet receive no relief from their obsessions because the thoughts get wired into the electrochemical systems of the brain and take on a life of their own. I was fortunate that therapy helped me because much of the strength of my obsessions came from keeping them a secret for fear that I would lose love and respect; sharing them with a therapist had a salutary effect.

After this first incident, I got into a cycle where about every seven years I would suddenly start to obsess seriously and have a rough time for several months. Intrusive and painful thoughts would come, causing shame and making it very hard to function efficiently. The pattern of treatment went like this: after trying to lick it on my own, I would revisit the therapist’s chambers and generally get relief within a fairly short time after telling my story. When the bout was over, I would feel myself a stronger person, optimistic and ready to get on with a better life.

A good deal of my obsessing focused on natural processes that, left alone, take care of themselves just fine. For instance, after I had progressed with my music practice quite well, I became afraid that if I thought about what my fingers were doing while I was playing the saxophone, I would end up with fingers tied in knots and, eventually, produce nothing but grotesque squeaks. I have other areas of obsessive concerns that I still prefer not to describe, but the above examples are pretty characteristic.

The last major bout before the present one was in the early 1990s, shortly before I retired, but I emerged from that in what I thought was the best psychological shape of my life and had been “clean” from that point until late 2005.

I felt I was back at the beginning again. Where was the relative peace of mind and wisdom that are supposed to be concomitant with growing older after you’ve lived a long life with all its complexities and struggles? In earlier times, there was always the hope of a permanent solution—that through increased psychological insight I would find the reason and be done with it. But the obsessive capacity is genetic and thrives on chemistry, not analysis. Also, I was younger, more resilient, more energetic, busier—all the rest of it then. In the past I could always rely on the fact that I had time to make things better. Now, time was running out and capacity running down. My major props had been knocked away.

My obsessional problems continued without abatement for three years, which is a dramatic and unwelcome change from the much shorter duration of my bad bouts in the past. The confessional magic of sessions with a therapist that always worked before has not helped, I think, because in a way I had been using the therapists to avoid some of the responsibility of really grappling with my issues. I tried medication (which has never helped) and meditation (moderately helpful) and newer techniques like behavior therapy and cognitive behavior therapy, which have been very helpful and are now the treatment of choice for OCD.

Behavior therapy involves facing your anxieties head-on by writing scripts or taking actions that take the fearful consequences of your obsession to the utmost and don’t permit any rituals to soften the blow. For example, a person with contamination fears will put his hands inside a dirty garbage can and not be permitted to wash his hands for some time afterwards. Sounds almost barbaric, but it is effective because if the obsession is not reinforced by a ritual, the mind will ultimately adjust to and regulate the anxiety to an appropriate level. Cognitive behavior therapy (CBT) is a structured attempt to take the flood of negative thoughts and replace them with more realistic and positive interpretations. For example, if you are obsessing that you must do everything perfectly, you work on how unnecessary and counter-productive that notion is. I didn’t learn about these treatments until the mid 1990s.

I was able to continue my activities for the most part, though I have felt at times I was functioning in a pretty minimal way. I was much helped and supported by my wife and good, understanding friends. Having the steady structure of HILR has been a help. It’s been a boost to play jazz at lunchtime in the Common Room, which has been well-received, and to deliver a couple of musical presentations to HILR groups, including an enjoyable hour in Rhoada Wald’s “New York, New York” study group. A big plus for me has been the interest taken for the first time at HILR in the aging process—the darker side of growing older and facing new and difficult challenges—initiated by Rhoada, Peg Senturia, Hy Kempler, Stan Davis, and Prudence King. I think this is one of the most important developments at HILR since I became a member. It has encouraged those of us who have joined one of the groups set up to discuss and write about the issues of old age not only to do that, but also to put on the table some of the darker times we have gone through earlier in life. This is somewhat against the grain of the solidly upbeat, highly intellectual focus at HILR. Stimulating as that may be, I feel that these new groups bring a necessary counterpoint and added dimension to the notion of learning in retirement.

From my own standpoint, going public with at least some of the truth about my obsessional life is a milestone. When I first saw therapists, back in the 1950s, I would never tell anybody, and swore my family to secrecy because of my shame and the stigma that I believed (with some justification) was attached. After a long time, I mellowed on that score as therapy became rather fashionable, and I realized that people generally thought you were a more sensitive, interesting fellow if you were living the examined life. I think that 2,600 years ago, Buddha came closest to getting it right. You’re more likely to be happy if you can just let go of a lot of judgmental ego baggage. I have been enormously helped over the past two years by a wonderful therapist at Massachusetts General Hospital who is about my daughter’s age. She uses the cognitive behavior therapy and behavior therapy techniques I mentioned. Over the past year my obsessive anxiety has greatly reduced and I am looking to life in a way I haven’t for a while. But just recently I had a fresh attack that I’m quite sure will be brief but nevertheless is upsetting. So on it goes, and that’s the way it is with OCD.

Carl Jung used to love the phrase, tertium non datur, the third not given. Being something of a Hegelian, he believed, unlike Freud, in the give-and-take between the conscious and unconscious, both of which had contributions to make to mental health. Jung said that if that struggle was openly and honestly played out, a totally unexpected solution could arise. I know that it’s going to take me a while to embrace life as it is, and I know that I can’t go back to the days when I can rather naively look forward to things getting every day better and better in every way. What I am hoping for is a solution that will not be another compromise between conflicting parts of myself but some sort of integration, one that incorporates OCD and its ups and downs as a valid part of my life.

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