Wastelands of OCD

Let’s talk about what works and what works less. First of all, ignoring thoughts and living peacefully with them, ensuring they don’t affect our actions, is an incredibly challenging endeavor, and it was not something I succeeded at on my first attempt. Honestly, while I was frantically trying to prevent the horrific outcome I feared, living with anxiety 24/7, it was impossible for me to observe the terrifying thoughts like an outsider and continue with my life. I was speechless in front of the doctor who gave me this advice. Because it was such a naive suggestion, akin to recommending a diet to someone who weighs 150 kilos—completely detached from reality. But it turned out there is indeed a way to act as an external observer towards those thoughts and feelings. The problem lies in finding that path. However, when I consulted many experts known for their work on pure obsessions (from various online resources), or even my own doctor, the message they conveyed was that it wouldn’t help to reassure myself that nothing bad would happen, but rather I should act in accordance with my “core values”. This was an incredibly daunting piece of advice for someone who was living in a state of anxiety and fear, utterly devastated by a cloud of thoughts throughout the day.

 

To be more specific, when I had an endless stream of ruminations in my mind and the thought loops that calmed me down had become almost automatic, it was nearly impossible for me to make new decisions based on my general values to escape this whirlpool. While experts and resources told me that convincing myself that nothing bad would happen wouldn’t work, they simultaneously insisted that I should refer to my general values when making decisions regarding my urgent and immediate problems. Looking back from the future to that day, I can see how difficult my situation was. Because if I had been in a position to trust my general values, I would have easily identified the actions I needed to take and the decisions I needed to make.

 

But the reality was far from that. I don’t know how to explain this, but I’ll try. First of all, my day would start with horrific anxiety. Morning anxiety was nothing like the anxiety I experienced throughout the day; it was much worse. The chemicals coursing through my veins at that hour were far more ruthless. Fragility, the impending sense of unavoidable danger, the urge to take immediate action to prevent it, timidity, physical anxiety, the fear of getting out of bed—these feelings are indescribable, and no sentence or paragraph can even come close to conveying this state. When I got up, my body would move hesitantly with every step because I thought that at any moment I would have to confess my terrible obsession and ruin my life irreparably, leading to suicide. This was not just a thought; it was a tangible reality at that moment, and I had no strength to seek refuge in my general values to escape it. My only weapon was the calming explanations that could provide me with a bit of relief, but as I mentioned above, these explanations only worked temporarily. Like a parrot, I would reassure myself every few minutes with similar explanations that the horrific scenario wouldn’t come true, and this continued for months in my mind, clouded by a fog. Eventually, I slowly found the strength within myself to stop those calming thoughts in that fog. But it was not easy at all because if I didn’t calm myself down, I felt like I would ruin my life at any moment. In other words, taking a break from calming myself had the effect of increasing my fear, and no one wants to take more hits when they are already in a fragile state.

 

As you can see, there was a problem. While the doctor was unable to make progress and I had no opportunity to talk to anyone, including my family, I first aimed to stop the rumination. Stopping rumination is, in my opinion, one of the first and most important steps in this treatment because since it becomes automatic, it is much harder to address it. At a triggered moment, I mostly found myself unable to intervene in the conscious thought processes in my brain, as a series of 3-4 thoughts would automatically line up in succession, and as a result, whether I wanted it or not, these thoughts would be processed in my brain, leaving a soothing warm feeling in my heart. However, this warm relief was my enemy because there was no guarantee it would work in the next attack. Ultimately, there is no guaranteed method that will work to stop the obsession, yet strangely, each time, a person can think that the current thought is different and that this time it will provide relief and solve all problems, ending the obsession. However, I couldn’t see in that terrifying fog that all the thoughts were revolving around a similar pattern with slight variations, yet they appeared original to me each time. Of course, recognizing all of this at that moment didn’t provide any benefit in treatment.

 

The first task was to stop the rumination because, to apply the famous ERP method that the doctors mentioned, it was necessary to create space for new triggers. But when your brain is already caught in a 24/7 cycle of triggering and relief, the goal is not to create new triggers but to break the cycle of triggering and relief. As I mentioned above, there is such a sense of urgency and pressure of a horrific outcome in your chest that even automatic reassurances can be lifesaving, and you feel the need for them; otherwise, there is a constant pressure that everything could end at any moment. I reiterate, in such a situation, the issues of how to apply the treatment and what is right become intertwined, leading to a terrifying feeling of being trapped and a hopelessness of never being able to recover. This was so exhausting for me that the question of how the treatment should be and how I would escape the whirlpool with the right approach became an obsession in itself. Sometimes, even how I would respond to a trigger became an additional obsession that I would think about for a long time.

 

So, we talked about stopping rumination. How did I manage to do that? Let’s continue. Most doctors say not to calm yourself when a trigger induces anxiety, but the practical methodology for how to escape the automatic triggering and automatic calming mode while being caught in a 24/7 rumination whirlpool is not clear. Some doctors claim that rumination is a conscious form of relaxation and that we engage in it as a conscious choice. Frankly, I disagree with this because by the time I realized that rumination was automatic, months had passed since the onset of my obsession, and I had no idea how much of the thought sequences in my mind I was controlling, how much was an automatic repetition of parts I had previously controlled, and how much was surfacing automatically from my subconscious at that moment. In such a fog, while trying not to succumb to overwhelming anxiety, I believe the medical advice given to stop rumination should not be framed as "rumination is your choice, so stop it."

 

I will gradually get to the things that helped me here. First and foremost, I needed to recognize that rumination was indeed automatic, meaning that even if I didn’t intervene, calming responses could follow one after another in my brain. This realization was crucial because when combined with the principles of the illness and the theory of its effects, along with the reflex to catch the onset of rumination, I began to see a group of strategies emerge.

 

First, catching the onset of rumination requires being convinced that rumination is a bad thing and developing a reflex to notice the moment it begins by making that decision. However, developing this reflex takes months, so it starts with making that decision. The problem is that in such a fog and anxiety, even the smallest decisions feel nearly impossible and incredibly frightening. Therefore, what helped me here was learning the theory of the illness very well. Once I became knowledgeable about the theory and mechanics of the illness, I accepted that rumination was not something that helped me.

 

However, note that at this stage, rumination still dominated all my mental processes. In other words, having information and making a decision to stop rumination is just the beginning; it requires a long period of practice afterward. So, what was the theory of the illness? There’s no need to elaborate on this; all doctors explain it. The things that comfort us actually feed the illness, and the more various comforting explanations we find, the more we motivate our brains to produce counter-explanations in the same way. As a result, while automatic thoughts are battling within the same brain, we contribute to the relieving side because triggers produce anxiety. If we want to escape the whirlpool, we need to observe our thoughts from a distance and focus on our tasks, but saying this doesn’t help at all. What is the methodology?

 

Let's continue. While battling the fog in my brain, I thoroughly understood the theory above and became convinced that rumination is an enemy. An enlightening realization emerged here: the battlefield of the illness is my brain, and while trying to remain indifferent to the thoughts it produces, I can also take some thoughts seriously and make decisions about them as if they were normal thoughts. In other words, while it is possible to engage with topics related to how the illness operates using the same brain, it is necessary to refrain from engaging with issues related to obsession. More clearly, while aggressive or automatic comforting thoughts are ineffective and I need to maintain a distant observer stance towards them, I could engage with topics related to the theory of the illness. All I had to do was identify which topic flowing through my mind belonged to which group. Thus, I made a conscious effort to fully understand all thoughts regarding the operational system of the illness and to convince myself about what the correct treatment should be. In doing so, I took the first step by deciding that rumination is my enemy. This was just the beginning of the journey.

 

At this stage, I was trying to catch the onset of rumination and practice the exercise of stepping back from involvement. I say stepping back because, when comforting thoughts suddenly arise in your mind in response to the same threat or trigger in your environment, it’s not immediately clear whether you are actively engaging with that thought or simply observing a flow of thoughts from the outside. As I mentioned earlier, a critical piece of information I gained while thoroughly learning the dynamic attack strategies of the illness became prominent here: it was impossible to intervene and stop a thought, whether it was aggressive, friendly, automatic, or appeared to be conscious—regardless of its type or how it emerged. At this point, a new reality emerged that truly opened the doors to being an external observer. The type of thought or its mode of emergence was irrelevant. A thought was a thought, and I didn’t need to expend mental energy on additional processes to determine which thoughts I should remain indifferent to—aggressive thoughts—and which ones were irrelevant to my obsessions and didn’t require me to remain indifferent. A thought, regardless of its content, was simply there and could remain there. By experimenting with this, I aimed to maintain distance not only from threatening ideas and images but also from harmless and normal thoughts. The challenge here was that, while dealing with obsessions, you accepted that there was an illness, which made it somewhat comforting since it wasn’t entirely your fault. However, because you chose to be distant from all thoughts yourself, you felt utterly crazy. For instance, when we talk about being neutral towards a thought like running the washing machine, it better illustrates the strangeness of the situation.

 

I believe the reason this system works is due to a situation resembling temporary memory loss that renders the effort to find comforting thoughts in response to obsessions meaningless. The problem is that the same thought that convinced you three minutes ago suddenly becomes invalid and no longer provides relief. As a result, you find yourself in a constant search for good ideas. When a new attack occurs, it’s as if all thoughts are reset due to this temporary memory loss, leaving you alone with the torment created by the aggressive thought. In that moment of temporary memory loss, either the subconscious suggests a new idea, or another previously used automatic response emerges. The worst reaction would be to seriously exert effort in searching for and finding a conscious thought of relaxation. Remaining equally distant and indifferent to all thoughts, whether good or bad, friendly or hostile, requires a vacant stare that does not concern itself with the quality of the thought, and in this regard, it aligns closely with the temporary memory loss state I mentioned earlier. In other words, you notice the existence of the incoming thought but do not analyze it, and this temporary memory loss state actually aids in that process.

 

As a result, I remember the first few times I managed to remain unanswered and as an external observer. It was truly a disconcerting feeling of emptiness and inexplicability within me. Interestingly, after partially stumbling through this practice, my anxiety in the face of aggressive thoughts decreased. I attribute this situation to the positive feelings I experienced from the success and the neutrality that made my brain reluctant to produce anxiety. But make no mistake, my anxiety was not gone. When an aggressive thought or image first emerged, my body was still producing anxiety before I made the choice to remain indifferent, and this physical anxiety was very painful. However, at least there was a glimmer of hope now, as for the first time in months, I had a somewhat effective game plan in my hands.