Alongside these thought-challenging exercises, I had to perform a series of behavioural ‘experiments’. Mostly, I remember crossing a lot of roads in places and at times where it didn’t seem 100 per cent safe to do so, in order to establish empirically that I wasn’t going to die in a freak road accident as a result. This modification of my road-crossing behaviour would be beneficial in two ways: firstly, it would give me empirical evidence with which to challenge my exaggerated risk assessments; secondly, by confronting again and again the stimulus to which I was sensitized, and not avoiding it, I would become ‘habituated’ – the opposite of ‘sensitized’ – to that stimulus and my anxiety would diminish as a result. This is a technique called Exposure and Response Prevention, in which the patient feels the fear, does it anyway, feels the fear diminishing, and discovers through experience that, after sufficient exposure to the feared stimulus, the anxiety will begin to tail off of its own accord. It’s not just logical: it’s physiological.
We also began to address what lay behind my negative thought habits, using a method which Ben refers to as ‘schema focus’ in his first letter. Feeding into the cycle are the patient’s schemata – their patterns of apprehending themselves, other people and the world in general – which are informed by their ‘core beliefs’. These beliefs may be partly the product of early experience, and this will be acknowledged by the therapist, but these early experiences will not be the main focus of the treatment, as they may be in other forms of therapy. I remember that we touched on my experiences in primary school, and discussed how they could have led to something like the following core beliefs:
I am bad, and deserve bad things to happen to me.
People cannot be trusted.
The world is not a safe place.
If you feed these into the CAR – CROSSING – SQUELCH cycle, you can see that I deserve to be run over, that I have no reason to think that the driver cares about my safety, and that it is in the nature of reality that, every day, thousands of helpless souls are squelched into road slime and nobody cares.
As Ben wrote in his second and final letter to my GP, after a six-week course of treatment, the approach produced rapid and observable results:
Her self-rating questionnaires have all reduced in score. She is now able to challenge automatic thoughts more effectively and normalises her changes in mood. She has been confronting her avoidant behaviour whilst out (confronting her thoughts of being more at risk than she actually is) . . .
Treatment has also helped her to look at past issues and has resulted in core beliefs based around the idea that everything that she believed she excelled at has been simply put down to academic capacity. We have explored a broader sense of self whilst putting into perspective developmental issues . . .
We therefore have not arranged to meet again. She tells me that she is reducing her Prozac under your monitoring and is on 20mgs every other day and is not suffering any ill-effects.
I could cross roads by myself now. I had dared to Google the Married Man and found plenty of virtual evidence that he was alive and didn’t have AIDS. I had discovered through practical real-world experiment that if I joined Friends Reunited, no one who knew me at school would send me angry messages telling me how horrible I had been and how much they still hated me. I had testified, on paper, that I was not ten years old any more and that the world, and I, had probably changed a good deal since then. I was happy enough to reduce the Prozac again, as I was appalled by the thought of becoming dependent on a drug as well as on other people. At the same time I was having more and more baby thoughts, and a pregnancy on antidepressants seemed far too risky to contemplate.
I had talked to Ben about my baby thoughts, and the fears about pregnancy and childbirth which had begun to take up so much of my ruminating time. When I met with my supervisory board at the university a few months later, I told them about my very real intention to have a baby, and cited this as the main reason why I could not cope with the prospect of the extra year’s field research, which one member of the board told me I would need to make my thesis at all credible. The board member responded that babies and PhDs were by no means mutually exclusive. My supervisor said to me after the meeting that he wouldn’t worry, that in his opinion the research I had already done was sufficient. But what the board member had said chimed in too neatly with my own fears about my work; now I knew for certain that I couldn’t face my thesis any more, that I had ceased to believe in it or be excited by it months or even years ago. My methods weren’t valid and I was far from reliable. I threw the whole thing over.
It was a great relief. I wouldn’t have to face the work any more and I wouldn’t have to travel to supervisions any more. And as I had finished my CBT with Ben, I wouldn’t ever again need to take taxis to an insalubrious part of Cambridge after dark and then wait outside for a taxi to take me home afterwards. Life was better all round.
28. Paula Heimann, ‘A contribution to the problem of sublimation and its relation to processes of internalization (1939/42)’ in About Children and Children-No-Longer: Collected Papers 1942–80 (Routledge, London, 1989)
29. I’ve just put ‘Quotation Family Writer Finished’ into Google: apparently it was Czesław Miłosz, and what he said was: ‘When a writer is born into a family, that family is finished.’
30. In letters to and from GPs, as I’ve discovered, one is always ‘a lady’, sometimes even ‘a pleasant lady’.
31. You can find an example of a statement from the Padua Inventory, which is used to diagnose OCD, at the beginning of each chapter.
Risk
36. I imagine catastrophic consequences as a result of absentmindedness or minor errors that I make.
The Padua Inventory
———
Mothers were careful to avoid any upset, but unfortunately many of the old wives’ tales persisted and new ones developed along the way. Things that were believed to be damaging to the unborn child were very difficult to dodge: birthmarks were considered to be the result of the sight of something frightening during pregnancy; harelips caused by the sight of a hare; and green eyes from seeing a snake.
Petrina Brown, Eve: Sex, Childbirth and
Motherhood through the Ages
There is an awesome fecundity to OCD: all the time it throws out new shoots, new runners – new compulsions, new obsessions. It is as stubborn and prolific as Japanese knotweed. A new obsession can generate from the tiniest seed: an offhand remark, a ten-line news item, a passage in a book. Here’s just one example: I went through an Iris Murdoch phase in my early twenties, and one of the books I read was An Accidental Man. In one particular scene, a character – I think her name is Charlotte – takes a bath. Rather foolishly, she balances an electric heater on the side of the tub; it is plugged in; it falls into the bath and she is electrocuted. I sincerely wish I had never read that book: ever since, when my OCD has been particularly bad and I have stepped into a bath, I have been tormented by the image of a live electrical appliance falling into the water, with fatal consequences.
Rather neatly, my OCD was at its most fertile when I was pregnant, and one of my most powerful obsessions, the one that would drive me back to the doctor’s surgery, and back onto medication, was triggered by something a builder said.
It was February 2003. I was well into the second trimester of my second pregnancy, and we decided to get some work done on the house. We wanted to put a downstairs loo in before the baby arrived; our boiler was coming to the end of its life and needed replacing. The builder we chose came highly recommended and when he came round to give us a quote, he seemed to sweat trustworthiness from his very pores; he fairly reeked of the quality. He discussed the work to be done in a clear and methodical manner, asking the right questions, explaining all the ways in which he could head off potential problems and save us money.
We were so pleased with him that we took him upstairs to see what he had to say about our loft. It had been converted into two tiny rooms by previous owne
rs. They had been very keen to do everything themselves and so had left a legacy of convoluted pipework, redundant wiring and this cramped and ill-lit loft conversion.
Before we even reached it, he was horrified: to reach the two loft rooms, we had to climb two flights of stairs that ran across the middle of the house, and the first of these flights, from the ground floor to the first, could only be accessed from the dining room. This meant that nobody in either loft room could leave the house without crossing another room, which meant, he said, that there was no safe exit in case of fire, which meant that the loft conversion was illegal, which meant that no reputable builder would even think about putting in bigger windows or replacing the plasterwork unless we first had the lower flight of stairs moved round ninety degrees. Did we have a fire exit? No, we didn’t. Did we have any fire doors? No. Did we not, at least, have communicating fire alarms? No. Why then, the loft was a fire trap! He looked shaken, as if a conflagration were already taking place in his head.
To the best of my knowledge, the loft rooms had been in use, one way or another, for twenty years and in that time nobody had died of anything in either of them, but the builder’s anxiety communicated itself to me and took a powerful hold. The room at the back of the loft was – and at the time of writing, still is – my office, so I spent a great deal of time in it. I had felt very secure in there, tucked up under the roof beams, but now I realized that I was working in a death trap. I was a highly vulnerable pregnant woman sitting at a desk in a death trap.
I had a good idea as to how the fire might start: it would be the portable electric heater that would do it. This heater was nothing like the more primitive one that had done for Charlotte in her bath. It was a shallow upright metal box with no exposed elements, and never grew so hot that I couldn’t touch it, but I knew that none of this would matter in the terrible event. The door to the room was at one end, and inevitably one day I would find myself in the corner furthest from it. On that day, the furniture would happen to be grouped in a particularly unfortunate way, with my upholstered desk chair pulled up next to the wooden writing desk under the window, and the heater standing just behind the desk chair; the heater would then be positioned between the chair and a wooden bookshelf loaded with flammable paper. There would therefore be no way that I could leave the room without touching the desk, the chair, the bookshelf or the heater itself. If – when – the heater came into contact with the back of the chair long enough to set the upholstery on fire, all that wood and paper would go up in an instant, leaving me – remember I’m in the furthest corner – trapped, unable even to reach the phone point with the spare phone, because that was in the front of the loft.
I could not relax and settle down to work until I had figured out a foolproof escape route. I guessed that once the chair had caught fire there would be a brief space of time – a minute, perhaps – before the desk succumbed, so that if I noticed the fire quickly enough I would be able to climb onto the desk, crawl across it without touching the chair, climb off the desk and then slip out through the door. If the fire had already taken hold behind the chair but not in front of the chair then I would have to consider climbing out of the window. This might not be too dangerous as the window opened out onto the sloping roof above the bathroom. If I stepped carefully onto the roof I could skid or roll down it until I got to the edge, where I could drop onto the lower sloping roof over the kitchen. From there it would be another short and easy drop onto the ground, and safety. I reckoned that if I could manage not to fall off the first sloping roof, the baby and I would probably both be all right.
So I had my plans, but I still wasn’t satisfied. Schools and offices had fire drills to check their procedures, so I thought that perhaps I could reassure myself by having a fire drill of my own. Obviously, I couldn’t test out the window option – that would just be silly – but I could at least see how feasible it was to try to climb across the desk without touching the chair. I arranged the furniture as it appeared in the worst case scenario – first making sure, several times, that the heater was switched off. I stood at the corner of the desk, put my hands flat on its leather top and lifted my left knee.
At least I tried. I am a small woman with short legs, who would find it hard to mount a desk from the floor at the best of times, but on that particular day I was doubly handicapped, firstly by my growing pregnant bump and secondly by the maternity skirt I was wearing, a long, tapering denim number that hobbled me, and which I would soon discard. I put my foot down, arranged my hands slightly differently, and tried again. But it was no good; I couldn’t get enough leverage to get myself up. I tried again, lifted my knee for the third time, and leaned forward. It was at that moment, in my loft, as I leaned on my writing desk in impractical French maternity wear with one knee slightly raised, that it suddenly occurred to me that I was going mad. I put my foot back on the floor.
It wasn’t really all that surprising that I should end up trying to mount my desk, bump and all, in a tight maternity skirt. Quite apart from anything else, everyone expects pregnant women to go a little mad: anxious, emotional, weepy, vague. The mum-to-be literature warns women about this, that it’s a huge life change, that you might need to mourn the loss of your pre-baby carefree self, that you might well be apprehensive about how you will shape up as a mother, that you might be upset to find yourself getting fat. They suggest that you might find it helpful to talk to somebody about this, or to have a bubble bath. You must remember that your body has undertaken an enormous task, that you are bound to notice the strain and that, most importantly of all, mind and body alike have been thrown off balance by a massive onslaught of HORMONES.
Some books list the hormones for you and tell you exactly what they do. A couple of them – oestrogen and progesterone – will already be familiar to you as the regulators of your monthly cycle, but in pregnancy, their levels rise enormously, as they have a huge range of new tasks to perform between them: suppressing menstruation, increasing temperature and breathing rate, relaxing muscles, helping the breasts to produce milk and strengthening the uterus. They are joined by other hormones, such as relaxin, which unlaces the body ready for childbirth, and oxytocin, the broody hormone, which will stimulate the contractions when the time comes, assist with the production of milk and make your eyes mist over whenever you see a really tiny pair of socks. In the second and third trimester, some of these hormones are secreted by the placenta, a whole new organ which the mother’s body generates in the first trimester, uses for the other two and then expels after the birth. Your blood volume will increase while your brain volume – for better or worse – does the opposite. Parts of your body may darken. Your hair may get thicker and shinier or, alternatively, start to fall out. You may go off sex, or want it more. Some women find that their pelvic tissues soften too much, and they develop symphysis pubis dys-function, making it painful to walk. Many women report the most vivid and peculiar dreams. A few are troubled by excessive saliva.
Meanwhile, the world seems to change around you, and it isn’t just your hormones making you imagine things: all of a sudden, society at large has obtrusive, disabling OCD. One of the main ways in which OCD presents itself to the sufferer – as opposed to the observer – is as an overwhelming sense of personal responsibility, particularly where possible harm to the self or others is concerned. The moment a woman conceives, she becomes responsible for seeing that no harm comes to her child and no one allows her to forget it. (A recent – and notorious – article in the Washington Post32 took this even further, drawing on a government report on the health of women of child-bearing age to suggest that all such women should regard themselves as permanently ‘pre-pregnant’ and limit their activities accordingly.)
Drugs and cigarettes are out, for a start – not a problem for me. Neither was the advice that I should drink only the occasional glass of wine, as I could never hold my drink anyway. I was given a list of foods to avoid, such as pâté and unpasteurized cheese, as these could harbour listeria.
I was also told to avoid eating liver (because of vitamin A) and swordfish (because of mercury) along with pre-cooked foods, ready meals, bagged salads and pre-packed sandwiches, just in case. I was told to wash my hands after touching the cat because of the risk of toxo plasmosis. I did my best to follow this advice to the letter, agonizing over every tiny choice. I dutifully took my folic acid for the first few weeks to reduce the baby’s chances of developing a neural tube defect. I rested, as I knew I should. I slept, as the books advised, on my left side, so as not to restrict the flow of blood to the womb.
While I took care of myself and my unborn child, we were carefully monitored, measured, checked and surveilled. At my ‘checking-in’ appointment, the midwife gave me a folder of notes which was to contain information about my health, any previous pregnancies, my marital status, my occupation, my lifestyle – anything regarded as relevant to the pregnancy, which seemed to be just about everything. On a regular basis, she measured my bump and listened to it. An ultrasound machine allowed the hospital staff to see inside my body and inspect the baby’s for defects. My blood was checked to make sure that I was immune to rubella, which I’d already had, and also to see if I was carrying syphilis, which I knew I hadn’t had. At eighteen weeks I took a ‘glucose challenge’ test, which sounds like a sponsored fun run but which actually involves the consumption of a bottle of Lucozade followed by the production of a precisely timed urine sample. It’s a way of screening for gestational diabetes. Not all hospital trusts bother with it. Unfortunately for me, mine did: I hate Lucozade.
Woman Who Thought too Much, The Page 23