OCD

I’m going to start this description of OCD in my household by quoting some of Irvin Yalom’s comments on OCD in the context of his existential psychotherapy. He is particularly interested in the connections between OCD and death anxiety. This overview of his remarks will set out part of my frame of reference in approaching this subject.

“Many clinicians have described the presence and the transformation of death anxiety across the entire spectrum of clinical psychopathology. R. Skoog reports that over 70 percent of patients with a severe obsessional neurosis had, at the onset of illness, a security-disturbing death experience. As the syndrome develops, patients are increasingly con­cerned about controlling their world and preventing the unexpected or acci­dental. Patients shun disor­der or uncleanliness and develop rituals to ward off evil and danger. Erwin Strauss notes that the obsessional patient’s disgust at decay, illness, germs, and dirt is intimately related to fear of personal annihilation. W. Schwidder observes that these obsessional de­fenses are not entirely effec­tive in absorbing death anxiety. In a study of over a hundred obsessional-pho­bic patients he notes that a third feared constriction and darkness and that a somewhat larger proportion had explicit death anxiety. D.B. Griedman describes an obsessional patient whose death anxiety took the form of an obsessive thought that he would be forgotten by everyone. Linked to this was his preoccupation that he was always missing the exciting things in the world about him: ‘Something really new happens only when I’m not around, before my time, or after my time, before I was born or after I’m dead.’

“Death anxiety is only thinly disguised in the hypochondriacal patient who is continually concerned about the safety and well-being of his or her body. Hy­pochondriacal illness in a patient often begins after a severe illness suffered by that patient or by someone close to him or her. Early in the course of the af­fliction, V. Kral observes, there is a directly experienced fear of death which is later diffused among many body organs. Several clinical investigations have reported the central role of death anxiety in depersonalization syndromes. Martin Roth for example found that death or severe illness was the precipitating event in over 50 percent of patients repor­ting a depersonalization syndrome.

“There neurotic syndromes share one important common feature: though they inconvenience and restrict a patient, they all succeed in protecting him or her from overt and terrifying death anxiety. If one is consumed by obsessive ruminations about cleanliness or whether doors are locked, then it seems to make sense to translate these superficial concerns into more fundamental meanings [i.e. fear of death].

“May Stern, in an important article, describes six patients mired in an intermi­nable analysis. In each instance the working through of death anxiety brought the analysis to a successful conclusion. One representative patient was an ob­sessive-compulsive male with symptoms of insomnia, nightmares, hypochon­driasis, and the obsessive fantasy occurring in sexual re­lations that he was being sat upon and breathed into. Much analytic work had been done on oe­dipal and preoedipal levels. The meaning of his symptoms in terms of castra­tion anxiety, incestuous feminine identification, pregenital re­gression, oral in­corporation, and so forth had been explored, but without the­rapeutic effect. Only when the analyst moved to a deeper level – the meaning of his symp­toms in the context of death fear – did the clinical picture alter. Finally, transference material referring to a wish to get from the analyst a magical formula elicited the interpretation that he conceived of analy­sis as protection against fear of death, and that no one was able to pro­tect him against inevitable death. This interpretation effected a surpri­sing, almost dramatic turn. It brought into analysis his permanent fears of dying manifested in his hypochondriacal complaints, his desperate struggle with the fear of nothingness in the beginning of his latency pe­riod, and his wish to stay forever in analysis.”

[I. D. Yalom, Existential Psychotherapy (1980) at 48, 49, 56, 195.]

Several of my former in-laws (i.e. my ex’s parents and siblings) suffered from or exhibited symptoms of OCD. That marriage lasted 20 years, so I got to observe up close for quite a while. After the divorce I worked closely for 4 years with a woman with OCD. More recently I have married again. And it seems that my sister-in-law has OCD. Over the past 25 years I have been in psychotherapy and 12-step settings in which I have also observed folks with OCD. Let me clarify that my relationships with these people have all been peer relationships, not therapist-patient relationships. I’ve been around the disease a lot.

I have become so codependently hooked into my current sister-in-law’s illness, i.e. her interpersonal behaviors that I have observed and that I interpret as OCD! I’m writing this at least partly to get some therapeutic venting. Or thinking out loud. Or both.

Here’s what I’ve seen. We 3 live in 1 large house on 2 floors. N and I live on the ground floor. T, the sister-in-law, N’s older sister, lives on the floor above us. But it’s all 1 house, and we freely move around in all of it.

We (the 3 of us) never leave anywhere until T is ready to go. House, church, bathroom break on the freeway, ANYWHERE! And she’s never ready to go on time.

When I first got here 7 months ago and N and I were courting and then planning our wedding, T had coughing fits. She hasn’t had any in a while, probably since we got married. She coughs, has coughing fits, in which she ends up ceasing to breathe, seems almost asthmatic. It’s so violent it stops what every one around her is doing.

She washes herself, especially hands and face, her accessories, and to some extent her immediate environment (e.g. chairs, etc.), many, many times a day, interrupting virtually any task undertaken. This results in the simplest tasks taking a lot of time. There is physical chaos all around her parts of the house. Stuff everywhere all over the beds, chairs, floors, and then it’s covered with sheets of newsprint. Even clothes inside drawers are covered with newsprint. Ostensibly to keep dust off of them. This is compounded by a marked tendency toward hoarding coupled with a general outlook premised on scarcity. There are plastic grocery bags folded up under all the couch cushions and mattresses, and empty cardboard boxes in every room of hers. Way beyond frugality and self reliance.

She suffers from insomnia. Terrible nightmares. Night terrors. She gets hot and then cold. Sweats, then her wet skin gets cold, causing pains. She says that she is allergic to dust, and her face and hands start burning if she doesn’t wash them often enough. She doesn’t want me to take her books to our area of the house, because then they’ll get dust on them and she won’t be able to read them. Not that I’ve ever seen her read any of them. She does read chruch magazines and books. She is consulted by N and has the final say on virtually every household decision. She verbally complains of headaches, lack of sleep, pains, and respiratory problems in great detail every day. She says that she is sensitive to subtle changes in the weather, which invariably bring her pains of various kinds.

She seems to have a generally unhappy disposition, though she would probably express surprise at the suggestion and deny it. She frequently criticizes N. She changes the way N is cooking or doing some household task. She can’t watch me pin up laundry to dry without telling me how to do it differently.

I’m told that she has a (presumably medically diagnosed) condition of hypothyroidism. The only treatments she takes are herbal and homeopathic remedies.

What do I make of it all? OCD, with hypochondriasis and insomnia. Hypothyroidism. N tells me that T is sick and is not bad. N still gets really frustrated at T and yells at her. They yell at each other often. I agree. She’s sick. I still get worked up (hooked in) over T’s behaviors. I believe her conditions are largely treatable and greatly reducible, with medications like SSRIs, thyroid meds, etc., and with psychotherapy.

Here’s an excerpt from my journal dated tues 9may06: “The continuing story of codependence in the household. Since Saturday N has had earaches, stuffed ears, stuffed nose, and general cold symptoms. She’s cried a lot. Been discouraged. T has had her usual aches and pains. She just got over an infestation of tiny (hardly visible) bugs that attacked only her in the entire household. But she can’t stand for more than 5 minutes and as a result after a morning of housework, all her aches and pains, particularly in the feet, legs, and back are aflame. Yesterday N got a referral from her family doctor to an ear-nose-and-throat specialist. So today we went to the first aid department of the hospital so N could be seen by an e-n-a-t doctor. T was in pretty good shape. While N and I were walking around the hospital being shuffled from one office to another, I listened to dozens of conversations of patients and their friends and families about their aches, pains, illnesses, etc., and those of others not present. I thought, “Boy, T would feel right at home here.” Finally, after an hour and 45 minutes of waiting, explaining, etc., we emerged with an order from the e-n-a-t doc to N’s doc for the latter to issue a prescription for antibiotics. When we got back to the first aid entrance, we found T in a wheel chair. She fell in the parking lot and banged her knee and twisted her ankle. N was furious! She yelled at T in front of everyone. She accused T of doing it on purpose. That was what I thought too. Not that T with premeditation deliberately threw herself on the ground. But I think that for T to keep being an invalid is a choice. The decision has payoffs. I think T is moribund by choice.”