On 13 May, the clinical psychologist at the primary care services wrote to the psychiatrist, and to my GP, to tell them that I had commenced my course of treatment with her the previous day. She reminded them that the psychologist who’d referred me had thought that ‘a brief, focused course of treatment targeting [my] significant avoidance behaviour would be most helpful’. The treatment would, therefore, focus on improving my self-confidence and reducing my avoidance behaviour in relation to my son. She added that I had asked if we might focus on my skin picking: ‘It became apparent that although her skin objectively looks fine, she is extremely concerned that other people will think her skin is “disgusting” and thus hides it as much as possible.’ Since my skin objectively looked fine, and since reversing an ingrained habit like skin picking was very difficult, and would take far more sessions than we had available to us, she suggested that it might be more helpful to ‘objectively assess’ how other people reacted to my appearance, and to work on reducing my anxiety about the issue.
I agreed, although I failed to see what was so objectively fine about the way I looked. Especially when I was sitting opposite one of the most beautiful people I’d ever come across in real life: flawless skin, fine bone structure, perfectly symmetrical features, etc., etc. I didn’t and never would look like her; therefore I disgusted myself, but I made an effort, for the sake of our therapeutic alliance, not to hold this against her. The following weekend, I bought a couple of sleeveless tops. I wore them a few times and noted that nobody around me threw up. Then I stashed them away in a drawer and managed never to wear them again, or buy anything else sleeveless. (All right, some of my sleeves are shorter than they used to be, but that’s as far as it goes – most of the time.)
At that first meeting, my symmetrical psychologist drew me a diagram to show how my anxiety, if I could only stay with it, would trail off by itself. Then she asked me to come up with a hierarchy of tasks that made me anxious, with the least stressful at the bottom and the most terrifying at the top, using SUDS as a rating system. I came back the next week with the following table:
Percentage
Activity
100
Taking a train with my son alone with changes.
90
Taking my son to Lammas Land [a play area across town] alone.
85
Taking my son by bus to the Botanics alone.
85
Crossing the road holding my son’s hand alone.
80
Taking a train with my son alone with no changes.
80
Walking with my son on reins by water alone.
75
Walking with my son holding his hand alone.
70
Taking a train with my son with someone else with changes.
70
Flying with my son and someone else.
70
Taking my son into town on reins alone.
65
Taking my son on the bus into town alone.
65
Crossing the road with my son on reins alone.
65
Walking with my son holding his hand with someone else.
65
Crossing the road holding my son’s hand with someone else.
65
Taking a taxi with my son alone.
60
Walking with my son on reins in the street alone.
60
Walking with my son on reins by water with someone else.
55
Flying alone.
55
Taking my son to Lammas Land with someone else.
50
Taking my son into town on reins with someone else.
50
Crossing the road with my son on reins with someone else.
45
Taking my son to the Botanics with someone else.
40
Taking a train with my son and someone else with no changes.
35
Walking to local shops with my son on reins alone.
30
Taking my son on the bus into town with someone else.
30
Taking my son somewhere in someone else’s car without Chris or Mum.
20
Walking with my son in the buggy into town alone.
10
Walking with my son in the buggy along the main road alone.
5
Walking with my son in the buggy to local shops alone.
3
Local shops alone.
I was quite pleased with this as a piece of work: it was neatly presented, its numbers meticulously calculated, and I felt that the repetition gave it a certain incantatory power. The psychologist was pleased too, and we were able to use it to set some realistic goals for the next fortnight: I would take my son, who at twenty-two months had only just begun to walk, on the bus into town with someone else – I already had my befriender lined up for this – and I would walk to the local shops with him. On reins. Alone. I completed my homework, ticked the items off the list, and at the next session agreed to move up the Ladder of Fear (as she didn’t call it), and tackle the two items I’d rated at 50 per cent.
We only had six sessions together, and the highest tick on the list is only at 60 per cent: ‘Walking with my son on reins by water with someone else.’ This was during an in vivo session the day before his second birthday, when I met the psychologist and her student on Jesus Green, and we took my boy down to the river. We stopped at the top of a flight of concrete steps which led down from the path to the water’s edge and I was told to take my son by the reins and start walking down them. We stopped at each step, the psychologist would ask me to rate my anxiety as a percentage, then we would chat for a minute or two and she would ask again. The percentage fell each time. At the conclusion of the experiment, I was crouching right next to the Cam with my son on reins beside me, pointing out ducks and driftwood. Later that session, I even took him off the reins – once we were safely back on the path – and we fed the ducks together. It showed, if nothing else, that these things were physically possible.
In the three and half years since the in vivo session, I have taken care of many of the more fearful items on the list, but, if I’m honest, this probably has more to do with my son’s growing all the time older and less acutely vulnerable than anything I’ve managed to do through deliberate therapeutic effort. I now cross the road holding my son’s hand alone (85 per cent) every day, with no more than about 30 per cent anxiety most of the time, and I can do this because crossing the road with a five-year-old is a completely different activity from crossing it with a toddler.
Then again, habituation does help – practice makes possible – with everyday tasks. The longer, more complicated, less regular trips, however, remain as abyss crossings. Last summer, I took a train with my son and my husband with changes (70 per cent) – and a boat too – when we travelled to the Isle of Wight for a holiday. Our son was perfectly easy to manage on the journey, but my anxiety wasn’t: too many trains, too many platforms, too many gaps between trains and platforms, too many people milling around making dangerous crowds on the platforms . . . Still, I did it, and there’s nothing on the list about not being a pain in the arse on the train with my son.
That’s it, I’m afraid: the most effective way to treat your OCD symptoms is, rather ironically, to make a to-do list, rate the items on the to-do list and then work up it, ticking as you go. It’s stressful to accomplish, and transcendentally dull to write about. I’ve always found the common-sense language of CBT to be rather disappointing, distinctly lacking in the colour and drama that makes psychoanalysis so attractive to read about and to engage in. I’ve been in the habit of seeing this as a flaw, but lately I’ve been coming to think that maybe the flatness of it is the point. If I look at the cognitive behavioural model of OCD with a poet’s eyes, the picture that emerges is of a person who is suffering from hyperbole, and perhaps an over-excitation of the met
aphorical: it’s not a thought but a PREMONITION; it’s not an impulse but the DEVIL’S PROMPTING; it’s not a spot, but a DISFIGUREMENT; it’s not anxiety but TERROR; it’s not a mistake but a FATAL FLAW. When I think about a journey, it’s an abyss. When I see an HGV coming towards me after dark, I see a stampeding monster, bearing down on me with flaming eyes. It’s not a realistic way of seeing things; it’s just not proportionate.
But then, as I’ve said, no one expects normality from a poet. We have something of a propensity for mental illnesses of all kinds, and female poets especially. I’ve seen it referred to as The Plath Effect. Psychoanalysts, psychologists, psychiatrists, psyfolk of all kinds have filled libraries with their efforts to figure out what the exact relationship between poetry and madness might be. Some suggest that there is a certain mental lability that predisposes a person to both: if you have it, chances are that you will turn out to be creative, or mad, or some combination of the two. Others see the making of poems not as a symptom, but as an ingenious attempt at self-cure, a kind of symbolic healing. I have seen research that suggests that, rather than there being a sharp distinction between poetry-as-art and poetry-as-therapy, the formal working-through of the poem on the page brings about a corresponding working-through of a problem in the psyche. Difficulties with emotion and experience are transformed on the page into difficulties with form, and as you find a solution to these, an acceptable compromise between the experience or thought you are trying to express and the means available to express it, there is a sense of real physical and emotional release. I say ‘you’ here – I mean ‘me’. And how do I know when I’ve finished a piece of writing? Well, I don’t for sure – that is to say, I don’t know objectively – but when I get that certain feeling, that release of tension, that sense of a task completed, I know it’s time to stop.
46. Lennard J. Davis, Obsession: A History (The University of Chicago Press Ltd, London, 2008)
48. David Veale and Rob Willson, Overcoming Obsessive Compulsive Disorder (Robinson, London, 2005)
49. Having said this so confidently, there does seem to be some new evidence that suggests that the impulse to hoard arises out of a distinct part of the brain, but I’m not going to interrupt the flow of my argument just for that.
50. For a fuller discussion of what I think of as ‘Macro-OCD’, see Risk: The Science and Politics of Fear by Dan Gardner, or Joanna Bourke’s Fear: A Cultural History (Virago, London, 2006)
Losses
29. After doing something carefully, I still have the impression I have either done it badly or not finished it.
The Padua Inventory
———
Some obsolete psychiatric diagnoses: phrenitis, melancholia, dancing mania, Scythian disease, oneirodynia, neurasthenia, nostalgia, spasms, monomania, hysteria, sexual inversion, nervous exhaustion, railway spine.
Then the certain feeling wears off and you realize you haven’t finished after all: there’s still something to add, or cut out, and maybe just tweak a little. Take hoarding, for example: I’ve only touched on it in passing, and it deserves more space than that.
Although it is usually included in lists of OCD symptoms, compulsive hoarding is seen by some as a quite distinct and separate category within OCD, and by others as a separate disorder altogether. Hoarders are far less likely than other sufferers to acknowledge their problem, or to seek help, and when they do, the medical and therapeutic treatments currently on offer are less likely to have any noticeable or lasting effect. They feel justified in their gathering and stockpiling of conventionally worthless things, in some cases even when they can no longer sleep in their bedrooms, cook in their kitchens, wash in their bathrooms, or open their front doors. The point they will make, to anyone who asks, is that you never know when you might want a thing, so you had better keep it, because if you throw it away, then it’s lost to you, and what will you do then? Anything might be valuable, and therefore, it is safest to assume that everything is.
In his section on compulsive hoarding, Penzel includes ‘an offshoot’ of the behaviour, a hoarding of less tangible things, such as ‘names, faces, facts or events’. This group of hoarders are concerned that they might miss or forget things. Like material hoarding, which may involve only one or two specific categories of objects, such as newspapers, lint, or string, the compulsions of those suffering from the offshoot disorder are often confined to one category of facts.
One sufferer I met had actually memorized all the names and complete specifications of all the world’s fighter aircraft, which he then had to keep studying daily in order not to forget the information. The thought of forgetting any of these facts caused him great anxiety. In addition, he had to save a very large library of books on the subject and constantly keep it updated as new types of aircraft were manufactured. He would read them repeatedly and drill himself on the facts. [Penzel, p. 247]
Yet another group have compulsions to hoard memories and experiences, not the kind of significant ones that most of us would expect to commemorate with cards, parties and photographs, but quite trivial experiences, often, again, in one particular category. One woman Penzel treated tried to hoard all her eating experiences, as she was never sure, for example, if this particular apple might be the last she’d ever see or eat, so naturally she would want to commit it fully to memory, just in case.
I wouldn’t call myself a pathological hoarder. I can happily throw all kinds of things away: packaging, newspapers, magazines, junk mail, worn-out clothing, knackered toothbrushes, blunted razor blades, food past its use-by date, last term’s school newsletters, broken plastic coat hangers, tins of dried-up paint – I’ve chucked them all out, and I’ve enjoyed doing it. Other things are harder to part with. I find it almost impossible to throw a book away, but then I am a writer, so I genuinely might need to look something up at some point (and so what if I live half an hour’s walk away from a copyright library – that’s half an hour I’ll never get back). Anyway, what some call hoarding, others might call building a library.
So, I can justify my books. I believe I justify them in a perfectly rational way. I believe that I can also justify my hanging onto every notebook I’ve ever used, all the letters and drafts of poems which other writers have sent me, and every draft of everything I’ve ever written, on professional grounds. For a start, I couldn’t have written this book without them.
But ask me why I find it so hard to throw away any of my son’s old toys, books, drawings, paintings, scribbles or flaking collages without Chris’s help, and the rationalizations run out. My first thought is always that I can’t make these decisions for this other person, and I imagine him looking for his lost things and not finding them; I’m aware, even as I think this, that my job as a parent is precisely that, to make decisions for another person, and also that my son is more likely to forget, rather than miss, what he doesn’t see every day. So, I have to admit to myself that I want to keep his old things for my sake, because they represent those earlier versions of my son, the obsolete versions, and it’s these – the baby, the toddler, the three-year-old, the four-year-old – that I can’t bear to lose.
Most of the things that I hoard represent lost or absent persons in some way. Like the horcruxes in the Harry Potter books, they do not just represent other souls, but are containers for pieces of those souls, which I feel myself responsible for keeping and preserving. Anything written by another person, whether they are a writer or not, comes into this category: sitting in my office are letters and postcards I’ve kept since I was a teenager, and autograph books signed by my classmates in primary school. I find it almost impossible to throw old photographs away, even if I have three copies of the same image, and this is especially true if that image has my son in it. To throw away a photograph of someone is to signal to some supernatural force somewhere that you wish that person dead, whether you really do or not. Throwing away a photograph is tantamount to manslaughter.
You’ll have guessed that I’m something of a memory ho
arder. Sometimes, I’m a fact hoarder too, though I prefer to call it ‘research’.
Whether it is a species of OCD or not, hoarding has this in common with other compulsive behaviours: it doesn’t work. A thought resisted will come back redoubled; a checked lock will only have to be checked again; all children grow older, and the day will come when everyone who ever was, is or will be in a photograph will be gone. Uncertainty, change, decay and death – you can’t wash, check, avoid, touch, count, pick, groom, arrange, step, jump, dance, reread, rewrite, confess, reassure or think them away. Accept them, or paralyse yourself.
For a start, if I can’t accept that I’m going to have to begin this paragraph in an unsatisfactory way, I won’t be able to begin it at all. I just caught myself picking my skin, which is something I still do when I get a bit stuck. It’s not as bad as it was, but I haven’t been able to stop. I still find myself hideous, and now I have ageing to worry about too. It didn’t help that, a few weeks after I finished my treatment with the symmetrical psychologist, I discovered that my hair was falling out: I had developed alopecia areata, another autoimmune condition. That loss wasn’t permanent, but it did leave me with another topic to obsess about, and another thing to check.
Early in 2006, I had strep throat, then sinusitis, then another bad cold on top of that. I told my GP that I was asking myself how many decades of this I was prepared to put up with, the illness, the inevitable deterioration. She switched me from citalopram to Prozac, and referred me back to psychological services. This time, I had a more sympathetic assessment, and I began a new course of CBT the following January. I’d started work on the book by then, and wrote about the cycling I was doing as part of my homework. I’m sorry to say that didn’t last. The therapist’s and my efforts to make me feel better about ageing, by counting the number of attractive and well-dressed mature women I saw walking down the street in one afternoon, or interviewing my mother and her friends about how good they felt about themselves, didn’t really do much either. Of course, I didn’t want to disappoint my therapist, so I pretended that it did at the time. We also looked at the high standards I set myself. The therapist asked me to write down my rules for living. For the first time in my life, I did so, and saw how harsh they were, how they contradicted each other.
Woman Who Thought too Much, The Page 31