tw: violent imagery, death

I have a complicated relationship with my body. But my relationship with my brain is even more difficult. Living with bipolar disorder and OCD has almost broken me many times. My OCD is exacerbated by stress. It will hibernate until it sees a scenario or chapter in my life it senses would be the most devastating to make an appearance. A time when I’m already overwhelmed with other things. Then it attacks.

Talking about my OCD as if it’s a separate, sentient being is a strategy I developed with my therapist. We refer to it as “the thought bubbles” after this funny song from the tv show Crazy Ex-Girlfriend. Because while some people are more consumed with compulsions, mine is primarily obsession-based. I am plagued with intrusive thoughts, distressing what-if ideas and images that pop into my head against my will and clamp down. Picturing these thoughts as foreign invaders helps me easier identify them as a symptom of my illness. This takes their power away. If I can laugh at them, even better. My therapist says humor is one of the best cures for OCD.

When I started writing, I had a specific moment in mind for my first intrusive thought. Age 9, in a home décor store on Ventura Blvd. But then I realized it was actually a little earlier. When I was around 7, my teacher began reading a beloved childhood classic to us aloud. Towards the end, a child dies from an accident with an axe. This saddened my whole class greatly. When you’re young, it is always a shock to realize death is not a fate reserved for the old.

Eventually everyone moved on to the next lesson, but I could not. I tried to do other things, think other things but my mind could not stop replaying the image of a swinging axe killing a child. Brushing my teeth. Axe. Eating lunch. Axe. Doing homework. Axe. Playing outside. Axe. The picture was vivid and gruesome, as if it had happened right in front of my face. I didn’t want to think such things, but I didn’t know how to stop. This thought gradually lessened, but continued to make unannounced appearances for years.

When I was a child, most of my intrusive thoughts were similar to this. Graphic, sudden flashes of bloody scenes that made me woozy. Decapitated heads. Close-ups of a leg breaking. Fingers accidentally getting hammered. And eyes. If you spend ten years constantly thinking about it, your brain can come up with so many different ways to harm your eyes. I’m shuddering now.

I’ve always been squirmish around blood, even my own. I’ve never watched a traditional horror movie because I don’t think I could handle it. So you can imagine the times when I was unable to picture anything else but these images were torturous. I felt as out of control of my thoughts as you do while in the midst of a vivid nightmare, but I was awake.

My OCD now takes on a different form. Instead of images, it’s based around possibilities. OCD was once referred to as the “doubting disease” in the 1800s, and that’s a pretty good description for my case. When my OCD flares up, the following is a pretty accurate example of my internal monologue. Enter me, driving down the street. I’ve italicized the thought bubbles.‍

What if I hit someone while I’m driving? That would be horrible. Yes, that would be horrible. But I would stop, I would help them. It would be okay. Anyway, I’m driving slow, I’m paying attention, I’m not on the phone or anything. That’s not going to happen.‍

But what if I hit someone and don’t notice? Then I couldn’t help them. What if they were alone? What if they were an old person? What if it was a baby??? What if a baby is just laying in the street and I don’t see it and I run it over? This is ridiculous. Why would a baby be laying in the street. Stop. Focus on driving. If I could run over a person and not notice… What if it’s happened before?? I’ve never ran anyone over. I would have noticed! This is impossible. What if I didn’t notice. What if… I ran someone over today? What if they’re laying by the side of the road right now, DYING?? And… Oh my god. I hit this person and didn’t stop. It was a hit and run! Oh my god. Oh my god. I did a hit and run. That’s a crime! I’M GOING TO JAIL. Wait… Am I more worried about going to jail than killing someone? I’m a horrible person. Now I’m freaked out that I’m both a fugitive and a murderer, or at least a bad person. Maybe I’ll check the car for blood. For a scratch. Some kind of evidence. There’s nothing, so I’ll get back in the car. But… what if I missed something? I might pull over and check again. Still nothing.

For some reason, driving related OCD is very common, the fear you might hit something or have already hit something and didn’t notice. Once I was stricken by this thought and pulled over four times to check the car for a scratch, in case I had hit someone’s car. I even also got a car wash just to make sure there wasn’t a scratch hiding under the dirt. Then, the thought evolved. What if my behavior is suspicious? What if when the police find me after this hit and run, they see I got a car wash. They won’t believe I hit them on accident. They won’t believe I didn’t notice I hit them. They’ll think it was on purpose and I was trying to hide evidence.‍

Are you exhausted yet? I am. In this example, the obsessions are car accident related. And me checking the car for scratches is a compulsion. But there is another kind of compulsion happening, rumination. By trying to talk myself out of this obsession, trying to disprove it, I’m actually prolonging its existence. If I had let the thought enter one ear and out the other, it would be over by now. But by trying to argue with it, hours have passed and I’m still obsessing. I don’t have many observable compulsions. Checking the car for scratches like in this case is a rarity. Most of my compulsions are rumination. I’ve seen OCD described as a beast by many people, and rumination as feeding the beast. So the “thought bubble” strategy helps to combat this. Once I think that first italicized thought, I realize it’s just a thought bubble and choose not to engage.

Oftentimes people with OCD give in to their compulsions trying to keep the obsessions at bay. This is true for me for the most part, but I do have one compulsion that has always stayed kind of separate. It isn’t in response to a specific obsession. It’s my general reaction to all stress and anxiety, but also a cause of great shame. Not only do I worry about people finding out and thinking I’m crazy, I don’t want them to think I’m gross and dirty. I have dermatillomania, compulsive skin picking. The following is a transcribed journal entry about it from when I was a teenager: I have scars all over my body. The feet and legs are the worst, but I don’t mind them so much. My mother is the one that’s offended when I wear shorts. My arms are better. They look a lot better than they used to. I barely even own any long sleeve shirts anymore. As a kid I always played with my scabs but this is different. The picking is uncontrollable. Sometimes I don’t even realize I’m doing it. I haven’t went a day without picking since I was 15. I’ve moved to my head because it felt like progress, to not be making anymore visible scars. I don’t usually think about the scars. When I’m wearing tank tops and flip flops, my skin is the farthest thing from my mind. But other people can’t seem to match my lack of interest. Like the lady in CVS who asked me if I’d just came back from somewhere tropical. She thought my legs were scarred by bug bites. Or the boy sitting next to me laughing at my story, when he interrupted me to point and say, “What the fuck happened to your legs???” I happened.

There are many more examples of reactions like this. People are unbelievably nosy. The whole time I was writing this, my head was itching, calling to me. I tried to ignore it but ultimately gave in. It was difficult to pick because I few days ago I cut my fingernails so short they almost bled. I thought it would stop me, but I’m resourceful. OCD can be an incapacitating illness. But I’ve developed a treatment plan which helps me to live a completely normal life with therapy and medication. It is daunting thinking about having to manage these same symptoms. ten, thirty, fifty years from now. However my old psychiatrist likened taking care of my condition to waking up each morning and putting my glasses on. When you look at it like that, it’s not so overwhelming.