I hate how the recommended treatment approach for ocd appears to be essentially wilfully neglectful of the anxiety. "Just don't do the thing so you can prove to your brain that it doesn't have the effect you're worried it will" would be a lot easier if therapists were better at acknowledging that these fears are contextually proportional responses to the intolerable situations that have produced them, even if they are not rational fears. And what the fuck is this about not seeking reassurance or not "enabling" reassurance-seeking by not providing it? Do you know how much trust you need to earn from someone before you going “I'm not going to engage with you to provide this thing you clearly feel like you desperately need because that's an unhealthy patten” doesn't just become a knife to carve a deeper wound with? I promise you you don't have that kind of relationship with most of your friends, and therapists definitely do not have that kind of relationship with most of their patients, because so many of them thing “buy-in” means “simply choose to trust me implicitly” instead of “give me the space to prove that you can trust me”.
Mine's “just” moral/severe harm ocd, at least until my medical anxiety gets triggered and then I do a bunch of dumb shit that I need to be sedated about because I can't stop myself. It used to be a lot worse, “I am putting the world in danger by being angry at people where God can see me” type shit, but it turns out all I had to do to fix that part was to abandon Christianity, so, win/win.
As is, I check messages I sent 10 or 15 times to make sure that they say what I think I said and that I didn't actually write something awful. Before I reference a past conversation, I revisit it several times if there's a log, because every time I start thinking about my answer I panic that I got something wrong. Do you know why?
Because of years of mistreatment, of gaslighting, of manipulation of my perception and feelings, of people finding fault in something I hadn't even known was there to find fault in, people inventing malice to assign to me based on the smallest of things, the most genuine and innocent of mistakes. So I learned to assume, no matter how improbable, that everything can be my fault somehow, that I am a glass box of butterflies scattering cyclones all across the world. Because the level of anger and amount of consequence I received for greeting my father with the wrong name when he walked through a door I wasn't even facing seemed as proportional to me as a meteorite killing us all is a proportional consequence of me privately wishing that he'd drop dead.
I could bully myself into not having the reaction to the emotion until I tune out of the emotion altogether. And then ten years down the road I could discover that actually I'm still here in that exact same state and that incidentally the dude who functions without the anxiety he tuned out is actually a Separate Person.
And maybe that's random. Maybe CBT/ERP didn't contribute to me being plural, even though I genuinely think it did. But you know what actually works better to help you avoid responding to compulsions and falling down obsessive spirals? When someone just commits to openly and vocally giving a shit about you. Someone could just say “Hey, okay, nothing bad is happening here, I trust you and I want to engage with you sincerely and I will not try to find fault with everything you do forever; In fact my desire is to believe there is something legitimate in everything you say and I will do my best to find it even if you don't communicate it perfectly.” Keep saying that and fucking stand by it in practice, until it adds up to the hundreds of thousands of times I was told and shown the opposite.
You're not writing code in a person's brain when you're simply telling them what behavior to repeat or cull, or at least not the code you think you're writing. It's like the fucking LLMs, they find patterns but not just the ones you sent them to look for. It's not what you should be fucking doing, definitely not as the main thing. You are engaging with a human being and encouraging them to just not react to their emotions and thought patterns while doing nothing to become part of the bubble of safety in which the patterns that taught their brains to work like this are actually not true. If you were doing that, they should be free to check and continue to receive confirmation that those patterns haven't somehow become true again until they get bored of checking.
All this shit because you don't wanna encourage reassurance-seeking? You wanna teach a group of people who, on some level, definitely already believe that the way it all feels doesn't matter and nobody cares that it really doesn't matter and nobody cares? Reassurance-seeking is a bad idea when it's inefficient, when it's wanting to text your friend every twenty minutes to double-check that the joke you made at lunch wasn't secretly bigoted, because there is nothing your friend could say that could convince you that nobody could ever find it bigoted. The solution is not to refuse to answer the question, it's to change it.
If I can ask and have it confirmed that you're not judging the value of my entire existence based on that joke, that you don't weigh our entire friendship against that joke, that if it were a harmful joke you would want me to learn to be better and you trust that I can so you'd tell me and help me and we would still be friends, and if you put your money where your mouth is often enough that I can believe you, then I'll live in a world where fucking up on occasion is safe, and I won't feel disproportionately responsible for everything and so my brain will actually stop feeding me garbage instructions about how I can micromanage the universe.
I know my examples don't map as cleanly onto "my friends will die if I don't do x" or "if I don't clean the house a third time today my children will get sick" or "I need to keep scrubbing this wound or it'll definitely get infected and they'll cut off my hand" (fun one from last year's hits), but if you use your head a little, you can see the distorted thinking patterns that leave someone with the impression that responsibility works that way, and you can create a pocket universe where you get to show them that the pattern that created the response has broken, rather than just insisting that the reasoning is false.
CBT is like, the most soullessly corporate take on therapy, it was literally developed as something that could be performed/provided by a machine, it's trying to fix humans like mechanical devices, it's Clockwork Orange bullshit.
And it's turning out to be a lot less effective on autistics. And the overlap/comorbidity is actually significant. And OCD (which is just a c/ptsd flavor and I will die on this hill) is just "everything is your fault so everything is your responsibility" disorder, passed through Google translate fifty times. Maybe we start there.
[if you had a good experience with your therapist or with CBT/ERP, this post is neither for you, nor about you. Please stay off it and write your response on your own blog if you absolutely can't help it, and do not tag me about it. Then again, if your treatment worked, maybe approach engaging with something that's not for you as a compulsion you should just choose not to comply with, regardless of the validity of why you feel so activated by it. How about that?]
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