I had an extraordinary experience Saturday night. I sometimes go to a group meditation. The types that go are those who believe in the metaphysical, and then there’s me. Yes, it seems I’m always on the fringe of most groups. It’s a truism that even in my own family, I’ve always felt like an outsider. I don’t think when I married I felt like I was truly part of a union. But that’s a tale for another time. It all changed when I had children, I’m happy to report. I finally created my own family. Back to the meditation experience (deduct 10 points for digressing). I very much want to believe that on some level, prayers are beneficial to the recipients. I believe action is better in every instance, but I would like to believe in the power of prayer.
I didn’t want to go to meditation Saturday night, I just thought that I should. I thought it would do me some good at the same time it was doing others good. We meditate on the world at large, New Mexicans, and ourselves in particular, asking for love, forgiveness, strength, whatever and whomever the participants add to the circle on any given night. The closer it got the more I didn’t want to go. I tried not to go. I left my house late. I got an ice cream cone on the way. I got there 20 minutes late and figured the door would be locked, but it wasn’t. I want to say that the cosmos wanted me to be there. I’m not sure what to make of it, but considering I had a cosmic experience not all that long ago, I have decided to be alert and aware.
The actual experience of meditation was, how can I say it? Uneasy. The first I don’t know how many minutes were blissful, and then my mind wandered. Some of the places it wandered, I really didn’t like. The rest was a struggle. Maybe I really needed to be there. Actually, I’m sure I really needed to be there. Even if my experience wasn’t optimal, and I’m not into the metaphysical, I believe I needed to be there. Wow. Me, needing to be a part of a group, even though I don’t exactly feel like I “belong” there. I still feel accepted and cared for. That’s pretty damned good!
I saw both of my shrinks today, the marvelous Dr. M. and the amazing Dr. K. I have to say that I believe that the lithium intervention is responsible for my current occasionally happy state. That and all of my hard work. And all of the love and support that people give me every day. Let me say that again, “All of my hard work.” I don’t want to say that my problems are all resolved, far from it. But I’m seeing light at the end of the tunnel. And I have worked very very hard to get there. Oh wait. I forgot…
I guess that my thinking is, that to be happy, you have to make a home in which happiness can thrive. What I mean is, we are all chasing happiness, but sometimes, all we really need to do is give it a hospitable home. Yes, it’s very complicated, and no, I’m not oversimplifying it. I have been studying happiness, in a way, since I started writing this blog. I haven’t been chasing happiness, just sitting quietly and trying to do what I need to do and what I want to do and making my life a place where happiness can come to roost. I wasn’t doing that intentionally, but in the process of taking care of my issues, I think I’ve allowed it to come into my life. I haven’t given up all worry or striving, but I’ve come to see that I have absolutely no business trying to tackle problems that aren’t mine. I have no business caring what certain people say or think or do. I’m taking care of myself rather than others. And I’ve spent a lot of time studying what other people say about happiness. I’ve shared this particular bit of wisdom with you before, but it bears repetition:
Now here’s a random thought. If anyone has any ideas on this, please let me know. The mind is an amazing organism, we’re all agreed upon that. “Experts” say that we only use 10% of our brain power at any given time. So my questions are, what would the rest of it be doing if we were using 100%? What would the function of the rest of the brain be? Why is the rest of our brain slacking? I don’t think my brain is a slacker. People with OCD have all kinds of brain activity going on at any given time. See your brain? It’s the one on the top. Mine’s the one on the bottom. See all of that red? That’s my brain spinning. Your brain is a slacker brain. If I were thinking great thoughts, I would have it made. Most of the time, I’m stuck in an obsessional thinking cycle. Seriously though, I do wonder about that now and again.
I’m going back in time–it’s very difficult to tell one’s history in a linear format, though one of my dad’s favorite expressions was, “The shortest distance between any two points is a straight line.” He generally said that when we were making something more difficult than it needed to be. Anyway, back to when I received my diagnosis–it was the fall of 2007. My house was in a state of disrepair, to put it mildly. One would believe that if one’s house were a horrendous mess, that one would have the wherewithal to clean it. But I had gotten to a point that I couldn’t. I was turning around in circles and steadily decompensating. It had been years that I couldn’t afford medication for the depression that has accompanied me my entire adult life. We were involved in the family court clinic because of my decompensation, and I had sent my children to live with their father. That same week I returned to therapy, got samples of Cymbalta from my primary care doctor, and nearly stepped out into the path of an oncoming truck intentionally. Being told I had a mental issues above and beyond depression was devastating. With depression, there’s always the possibility of not being depressed. I don’t believe that one can never have OCD, though I’ve come to believe that people can recover from many of their symptoms. At the time, though, I suppose I would much rather have thought I was just depressed, disorganized, and lazy. People often think of the mentally ill as lazy, when in actuality, they are debilitated.
When the court clinic representative told me about my diagnosis, I came to understand it. I would havegotten my house in order if I could have, and I couldn’t. Even so, I cried so many tears telling my mother, I shorted out my cell phone. The diagnoses were psychosis, a thought disorder, and histrionic personality disorder. Actually, when the dr. who conducted the tests told me, she said I had a histrionic personality and that was a good thing to have with children. I thought that was a positive thing. I guess she was trying to put a positive spin on it for me, bless her.
It’s hard to wrap your mind around a diagnosis, and I didn’t have enough knowledge to see how I had OCD. I didn’t count, I didn’t hand wash, and that’s about all I knew about OCD. My variety happens to be mostly about obsessional thinking, so I understand how I didn’t understand. I also have Compulsive Hoarding Syndrome, but I seem to have managed to keep it within limits.
I really came to understand OCD as it pertains to me the more therapy I had and when I read chapter 12 of The Sky is Falling: Understanding and Coping with Phobias, Panic, and Obsessive-Compulsive Disorders, by Rae Ann Dumont. The title of the chapter is Mr. More, the Man Who Couldn’t Throw Anything Away. I was blown away. With a few differences, you could insert my name and voila! You would know my situation. I’ve typed the entire chapter, hoping that it might resonate within a reader or two (and hope I don’t get in too much trouble for it!) I honestly felt so alone until I read this. I’ve italicized parts of the chapter where I underlined them when I was reading it, parts that amazed me because either I identified with Mr. More to a great extent, or because I didn’t know until I read them that my behavior was similar and didn’t understand until then why I did the some of the things I did. It’s long! But Ms. Dumont is an excellent writer and has a very dry wit.
When I was about fourteen I was drafted into helping my mother and aunt clean out the house of an elderly relative who had recently died. I’m not sure exactly how she was related; my memory of her is hazy, but I know with absolute certainty that I had never been in her house prior to the cleaning expedition.
The house was a little bungalow in sad disrepair on the outside. Inside it was stacked to the ceiling with boxes. Leading from the front door was a path about four feet wide with boxes of more or less equal size stacked on each side. The path led to the dining room, where there were more boxes. Piled on the dining-room table and chairs were more boxes. From the dining room the path split off and led to her bedroom and sewing room (both stacked with boxes). The kitchen was the only room with a semblance of normality. In spite of the boxes, the neatness and order of everything was dazzling. The boxes were stacked and aligned with precision, and every box was labeled and sub-labeled with a brief description of its contents.
In the bedroom:
SHOES–BLACK–Low heels (out of style)
SHOES–SUMMER–White & Beige (kind of worn)
In the dining room:
DOILIES–White & Cream–Large
NAPKINS–White Damask (for company only)
In the living room:
READER’S DIGEST–From 1942 to 1946
The house was a warehouse of her entire life. In awe I wandered along the paths trying to imagine what her thoughts could have been when she surveyed her accumulations. But I realized that such an understanding was way beyond my grasp when I found in the pantry a box, somewhat larger than a shoe box, that was labeled PIECES OF STRING TOO SHORT TO SAVE.
Mr. More was forty-two years old, single, and lived alone. He was a little overweight and had a slightly rumpled, disheveled appearance. He worked as an accountant for a large firm, and his constant obsessing on inconsequential matters was affecting his career. He estimated that he spent at least a third of his working day obsessing. He was able to keep up with the work by staying many hours overtime, but the tax season was approaching and his workload would double.
Mr. More obsessed about everything: “Did I remember to turn off the gas or lock the door? Should I have worn gray socks instead of black socks? The black socks look too drab, almost morbid. Will people think I’m morbid because of the black socks? If they think I’m morbid, they’ll think there’s something wrong with me. Maybe I can sneak out for lunch and buy a pair of gray socks and change them, but if I change them, where can I put the black socks? I can’t just throw them away. I can’t put them in my desk drawer; they might smell bad. What can I do with my black socks if I buy new socks? And what if someone notices that I’ve changed socks in the middle of the day…”
After a phone conversation with his boss he would think, I shouldn’t have ended the conversation by saying, ‘Have a nice day’; that’s too frivolous. He’ll think I’m a real twit for saying anything so silly. Or maybe he’ll think I’m being a smart alack. Maybe I should call him and tell him I didn’t mean it–but no, I can’t call him up and tell I don’t want him to have a nice day. Maybe I can call him and have another conversation and end it more intelligently. But what can I call him about? I can’t just call him for no reason except to end a conversation…”
On our third appointment Mr. More arrived very distressed. “Now I have a real problem,” he said. “That other stuff was just nonsense. I can’t get into my apartment, and I have to get in because I’ve got important papers in there.
“Why can’t you get into your apartment?” I asked.
For a moment he hesitated and then with exasperation said, “Because a stack fell in front of the door.” I started to ask, “What stack…?” when a picture of my relative’s house with all the boxes emerged from my long-buried memory. “Oh,” I said, “I think I understand.”
The previous morning on his way to work he had slammed the door shut (he always slammed it to be sure the lock would catch), and he heard a loud crash. When he tried to reopen the door it wouldn’t budge. He pushed and pounded without luck. He obsessed about the problem all day at work and then called his brother and arranged to meet him at his apartment door where well into the night the two of them tried to get into the apartment with no luck. During our conversation he remembered that there was a fire escape outside his kitchen window. (It’s not unusual that an otherwise obvious solution can be completely overlooked when a person is distraught.) While he was in my office he called his upstairs neighbor to arrange for Mr. More to crawl out the neighbor’s window, down the fire escape, and into his own window. Before he left we agreed that his apartment was in serious trouble and that our next appointment should be held there.
My departed relative’s apartment was neat and orderly–Mr. More’s was total chaos. The house of my memory had wide, clear paths. In Mr. More’s apartment there was no way to walk without stepping on stuff. Everywhere–all over the floor, the couch, the tables–were clothes, dirty dishes, plastic containers, empty bags, newspapers, magazines, books, and other objects of various sizes and purposes.
Mr. More had a problem throwing things away. He remembered that even when he was very little he couldn’t bring himself to throw away outgrown clothes. He saved the shells he found at the seashore and the stones he picked up at summer camp; he saved his comic books and all his school papers. His older brother drew a chalk line down the middle of the room they shared, and if any of Mr. More’s collection oozed over the line his brother would throw it out. In college he had a reputation for being a slob, but except for a few arguments with his roommate the problem never became a major issue.
The disorder got out of hand when he moved into his own apartment. Because he had a limited budget for furnishings, he picked up things he found on the street–a chest of drawers with one drawer missing, a wobbly chair, a table with a scratched top. The intention was always to fix and refinish the furniture and replace the pieces when he could afford to. Over the years he bought a water bed and an expensive couch, but the curbside collection continued to grow. He picked up appliances that didn’t work, mirrors that were broken, damaged furniture, stacks of magazines, worn clothes, and all sorts of objects of uncertain identity.
Periodically he would set aside a day for “housecleaning,” when he typically would pick up item after item, inspect it briefly, and decide that it was still good, or that he would fix it next week, and put it down again, leaving the apartment looking much the same as before the “housecleaning.” The collection grew and grew. Newspapers were saved because Mr. More worried that he might have missed an important article and felt that he should reread the paper. Worn clothes were saved because he liked them and he might wear them for painting or cleaning. Plastic containers were saved for storage. He saved grocery bags because they were still good and he could use them again. On numerous occasions his mother had attempted to help him. With his permission she took piles and piles of his things and deposited them on the curb for garbage collection, but each time after she left Mr. More started worrying about the possibility of something really important having been thrown out, until the anxiety was so great he was compelled to bring the things back in. His mother finally refused not only to help but even to visit his apartment. His collection continued to grow.
Mr. More’s social life was nonexistent. During his twenties and thirties he occasionally dated, but around the third date he would begin to obsess about his date’s reaction to his apartment. He would make such a point of not taking her to his apartment that she would become suspicious and break off the relationship. During his late thirties he maintained an affair with a woman for several years and avoided taking her to his apartment by telling her that she was married. After a couple of years of dating he told her that he was leaving his wife and moved into her small one-bedroom apartment. Soon he began collecting things he found on the street again. Eventually his woman-friend started to complain about the clutter. The clutter increased and the arguments escalated until finally the woman told him that she couldn’t live with him any longer.
Mr. More lived in fear that the superintendent of his apartment building would evict him. Once, using a passkey, the super went into the apartment to check for a water leak. He warned Mr. More to clean the apartment or face eviction. Since then every time he ran into the superintendent, Mr. More would give him five or ten dollars and say, “Everything is fine, the place is all cleaned up.” But the fear of someone coming into his apartment was always present. Except for the superintendent, I was the first person inside Mr. More’s apartment since his mother had left in disgust over ten years before.
The place smelled bad. There was nowhere to sit, hardly any space to stand, and everything was covered with the sooty, gritty dust characteristic of New york. I was beginning to reassess my commitment to in vivo therapy. “One step at a time,” I told myself. “First we have to understand what the fear is and then take one small manageable step toward it.”
The first step was to understand the dimensions of the problem. Mr. More and I stood in the middle of the mayhem, trying to establish a hierarchy for the collection. Large items, such as furniture, and articles that had personal meaning were the hardest to throw away. Objects that were interesting (a carved chair leg) or conceivably useful (plastic containers, broken appliances) were next on the list. At the very bottom of the list (therefore the most dispensable) were wrinkled paper bags. We started by wading through the mess. After about twenty minutes we had collected a stack of bags about a food high.
Our next step was to throw the bags out or to analyze why they couldn’t be thrown out. Mr. More didn’t seem to be having any trouble during the search and collect period, but as the time to throw the bags out approached I could see he was becoming agitated. I asked him how he felt.
“Not good,” he said, “hot good at all. I may have left something important in one of them. There may be an important paper or money in the bags. I really can’t throw them out until I’ve had a chance to check them.” I asked him how he felt physically. “Tense, my chest feels like it has a tight band around it, and there’s a lump in my throat and a bigger one in my stomach. I have to check the bags, I have a feeling that I left something important in one of them.”
“Shall we check them together?” I asked.
“No, you might not do it right. I have to do it myself.”
I stood and watched while he picked up each bag, opened it, put his hand in, looked inside, shook it, and put it down again. In some of the bags he found receipts for merchandise or groceries, may of which were seven and eight years old. Each of the receipts he read, smoothed out, and carefully put aside. After he finished the stack he started over.
“You’ve checked all of these, let’s throw them out now,” I said
Mr. More forcefully said, “No! I can’t throw them out until I’m sure I’ve checked them all. There might be something important in one of them.”
Two of the most distressing aspects of OCD are the questioning of one’s own reality and the need for absolute certainty. Other people are able to trust in their sense of reality (“I definitely remember locking the door”), or they can tolerate uncertainty (“I don’t really remember locking the door, but I’m pretty sure I did”). But the OCD sufferer is compelled to repeat an action over and over again. The goal in therapy is to develop trust in one’s reality and to learn to accept and live with uncertainty. At this point, however, these were still distant goals for Mr. More, so head had to repeat his checking.
When he had finished, we walked together to the garbage chute and threw the bags down. Back in his apartment I asked him how he felt.
“Great!” he said with a big smile, “I really think I can do it.”
“Sure,” I said, ‘we’ll work together and eventually we’ll be able to get this place cleaned up.”
Mr. More’s face darkened. “I meant I thought I could throw out the wrinkled bags, not everything.”
Trying hard to keep the dismay from showing on my face, I said, “Right, that’s a good place to start.” His assignment for the week was to continue to find and throw out bags; to keep a record of his thoughts; and to clear a space for us to sit down during the next appointment.
My assignment for myself was to reassess my own attitudes. Mr. More’s place was filthy. It caused me distress just to stand in it. I didn’t want to breathe the air; I certainly didn’t want to touch anything. I didn’t even have the courage to look into the bathroom or kitchen. I really didn’t want to have to go there again, but I doubted that sitting in my office and talking about how he should throw things out would be terribly effective. An important part of therapy is the acceptance and positive regard that the therapist communicates to the client. Would I be able to separate my revulsion for Mr. More’s lifestyle from Mr. More if every time I saw him I was offended by his squalid apartment? I decided to endure another session in the apartment, gently letting Mr. More know how I felt about it, and then go from there.
For the next session I prepared myself by wearing old clothes and carrying moist paper towels in a plastic bag so I could clean myself off afterward.
“I’m kind of surprised you came back,” Mr. More said. “Most people wouldn’t have.”
Mr. More had spent the entire week clearing a six-foot circle and clearing the junk off chairs. He hadn’t done the other parts of the assignment. It seems contradictory that people spend considerable time and money for professional advice and then disregard it, but there can be a myriad of complicated reasons for people not doing their homework assignments. Sometimes it is old leftover resentment from having been a school kid. Or real-life problems impinge, such as illness or an extra-heavy work schedule. Maybe the person lacks commitment and feels that it is a waste of time. Most often it is because the goal was too ambitious.
Although he didn’t throw out any additional wrinkled paper bags, he did put aside all those he found while cleaning so we could work on throwing them out together. We had another foot-high stack of bags and old receipts to deal with. I suggested that he tear the bags completely open and spread them out flat. While he did that I pulled out more bags and stacked them. When he finished with the first stack, we went to the garbage chute and threw down the bags and receipts.
On returning to the apartment, I noticed that Mr. More was getting agitated. “What are you feeling?” I asked.
“I’m feeling very tense,” he said. I’m feeling that tightness in my chest and the lumps in my stomach and throat. How do I know that you know what you’re doing? How do I know that you aren’t making me go too fast and will cause me to crack?” He clutched his chest and said, “Those receipts are gone now, I can’t get them back.”
“Why do you need to get them back?” I asked.
“They might be important,” he said. Maybe if I get the super he’ll open the door to the garbage chute in the basement.”
“Why will you need grocery receipts or receipts that are over two years old?”
“I don’t know, but I have to get them back. Maybe if I get the super he’ll open the door to the garbage chute in the basement.”
“If you get them back will that terrible feeling go away?” I asked.
“Yes. I think you’re making me go too fast. I can’t stand it. I should never have let you talk me into throwing those receipts away.”
Mr. More’s terrible feeling is an intrinsic part of an obsessive-compulsive disorder. The OC victim gets a frightening though (in Mr. More’s case, it was “What if I need those receipts?”); the thought creates the distressing physical sensations of anxiety, and the victim relieves the anxiety by performing a ritual. Sometimes the ritual is saying a litany; often it’s washing. For Mr. More it was keeping absolutely everything so he would always have whatever he might need. The most difficult part of getting over an obsessive-compulsive disorder is resisting the compelling urge to perform the ritual. Mr. More was misinterpreting the terrible feeling as an indication that something even more terrible would happen–he would “crack.” The overriding impulse is to avert that most terrible thing and get relief. But the OC trap is that every time the person employs the ritual to be free of the terrible feelings, and he reinforces the OC stranglehold. The dilemma is: allow the terrible feelings and uncertainty and eventually work free of OCD or perform the ritual and appease the feelings but intensify the OC behavior.
Mr. More was very angry with me. He felt that I had pushed him too hard and too fast and subjected him to unreasonable danger. I had to encourage him to allow the terrible feelings and help him to see that the feelings would go away without having to perform the ritual. Many OCD treatment programs expose the person to his most fearful situation or contaminant and then prevent him from washing or performing another ritual. So he may have to handle feces and not be allowed to wash his hands, or he may not be allowed to bathe for a week. This procedure really works for the people who are willing to enter the program and stay with it, but many people are averse to subjecting themselves to such a punishing treatment. The anger and stress Mr. More was experiencing could cause him to drop out of therapy. It was very important that I reinforce his ability to think rationally during periods of stress and to allow the feelings.
“Tell me about the receipts,” I said. “What were they? What could have been so important that it can make you so miserable?”
“I don’t remember what they were, I’m not sure that I saw them all. I shouldn’t have thrown them out.”
“We went over them together, remember?” I said. “We had two categories of receipts. One was grocery receipts; do you remember the other category?”
“I think it was receipts more than two years old,” he answered.
“Right! So out of those two categories, what could be so important?”
“I can’t be sure that I saw them all,” he said. “I can’t be certain that I read them right.”
“Would you have been likely to have mistaken a check or a fifty-dollar bill for a grocery receipt?” I asked.
After thinking about it carefully, he replied, “I don’t think so.”
“So what could have been so important?”
“I don’t know,” he said, “but I still have this terrible feeling.”
“What if we try to get the super to open the garbage chute in the basement so that you can retrieve the receipts? Will the feeling go away?”
“Yeah,” he said, “but I can’t do that. The super already thinks I’m a nut job, and besides, I’ll feel like a miserable failure.”
“So what you’re saying is that you’ll get short-term relief but long-term misery. The decision is yours: what will you opt for?”
Mr. More’s distress was severe. He was pacing and gasping for air. “I hate this,” he said, “why does it have to be so hard? On one hand, I know it’s irrational but on the other, I feel like I can’t control it. I feel that I have to get rid of these feelings. But getting rid of the feelings will only cause another set of bad feelings. I really feel like I’m going to crack; I can’t stand the stress.”
“I know the feelings are awful, but I haven’t known anyone to crack from them; they will go away, and it does get easier,” I said. “Let’s make a list of things that might really cause problems if you were to accidentally throw them out.”
Mr More’s list of things not to throw out contained: credit cards, driver’s license, checks, cash, contracts, and official documents.
“How realistic is it that you might have mistaken any of these items for an old receipt or a grocery receipt?” I asked.
“Realistically? Well, it’s not too likely, but it could happen,” he said.
“What would happen if you were to lose your driver’s license or credit cards or cash?” I asked.
“It would be a pin in the neck,” he said, “but most of the stuff is replaceable except for the cash, and it’s unlikely that it could have been so much money that I’d go broke because of it.”
“So what you’re saying is that even if you did mistakenly throw out something important the consequences won’t really be so dire.”
Mr. More breathed a sigh of relief. “I guess not,” he said.
By the time I had to leave, Mr. More’s bad feelings had abated. His assignment for the week was to continue to throw out the wrinkled bags and to identify and reality test his thoughts as we had just done.
When I arrived for our next appointment I noticed that the cleared circle around our chairs had shrunk to about four feet in diameter. The collection was beginning to close in on us again. However, Mr. More had done all of his homework. Wrinkled paper bags were stacked and ready to be inspected, and he had kept a record of his obsessive thoughts. Asking an obsessive person to keep a diary can be risky: Because obsessive people have a need to do everything completely and perfectly, they may end up spending most of their time working on the diary until it becomes another obsession. But Mr. More’s diary was concise, and it identified a number of anxiety-producing thoughts, which came as a bit of a surprise to me. I would have guessed that the majority of his anxiety-producing thoughts would be work related, such as: “Did I do that right? Should I recheck the figures? I should do it over again. What if I made a mistake?” However, they were all thoughts about social situations. “Did I end the conversation too abruptly? They must think I’m a jerk. I shouldn’t have worn this jacket.” I had been so diverted by the mess in his apartment that I had forgotten that his original complaint was whether or not he should have worn black socks or said “Have a nice day.” Again I was reminded that Mr. More had virtually no social life in ten years. To say that his social skills were lacking is to barely touch the surface of his problem. He didn’t have the first idea of how to interact with people on a purely social level. He didn’t know how to initiate a conversation or how to end it, or how to deal with any part in the middle. In his work he was very confident; he rarely had concerns about having made a mistake, so he almost never had obsessive thoughts about it. But office parties were totally out of the question. Business lunches were agony; even meeting someone in the hallway was difficult. He would obsess endlessly about what had been said or done.
Mr. More originally came into therapy because of his obsessive thoughts about social situations. He genuinely wanted friends and a relationship with a woman, but he knew that the condition of his apartment and his uncontrollable collecting would be a turnoff for most people. He earnestly wanted to work on both problems. It was his suggestion to spend the first twenty minutes of a session examining his social problems and the remaining forty minutes on the collection.
We started with modest social assignments, such as initiating a conversation while waiting for the elevator. We wrote out scripts: “Hey, what do you think about those Mets?” “Do you think the weather will stay around for the weekend?”
His personal appearance was a major subject of his obsessions, so he planned to buy a book on dressing for success. I delicately pointed out that even “success clothes” have to be cleaned and pressed in order to be effective. His clothes were strewn all over his apartment, and he usually looked like he’d slept in them. That led nicely to an assignment to pull out all the clothes he could find and take them to the laundry or cleaner’s, make space in a closet to store them properly, and return to the work of cleaning up the apartment.
The work progressed. When Mr. More felt comfortable with elevator conversations he graduated to water-cooler conversations. After we disposed of most of the bags (both wrinkled and “good”) and some of the receipts, we started on plastic containers. He kept ten; pretty ones went to the thrift shop, the others to a recycling center. When his clothes came back from the cleaner’s and he cleared out a closet for them, we lost our chairs and clean circle for a couple of weeks, but the annoyance of having nowhere to sit and talk motivated him to establish a neat area again.
Just getting to the magazines in Mr. More’s apartment took weeks. Each time we started on a new project, he suffered with the old terrible feelings and desperately wanted to retrieve whatever it was we had just thrown out. His assignments were to prepare things to throw out, but he wouldn’t throw anything out unless I was with him. He still needed me to help reality test and to allow the feelings. Often he would get angry with me and accuse me of putting too much pressure on him and making him go too fast, even though I always let him decide on the assignments and gave him the option of retrieving the stuff if he wanted to.
At a snail’s pace things were being removed from the apartment. Mr. More had begun to wear mostly clean, pressed clothes. Not only did he initiate conversations, he invited people to lunch on a couple of occasions. Mr. More was clearly getting better.
At the very start of therapy I always ask the person to establish short- and long-term goals, but OC people often have a hard time with planning because they are so overwhelmed with day-to-day difficulties. Mr. More had originally been unable to set any realistic goals. I felt the time had come for us to sit down together and reassess what we wanted to accomplish and what we needed to do in order to accomplish it. Mr. More had been enjoying small social success recently. His immediate short-term goal was to start dating again. The long-term goal was to get married and have a family. He found that his obsessing at work had diminished considerably. Although he didn’t expect to ever be completely free of obsessing, he felt that he could reduce it even more. The techniques of identifying and categorizing the cognitive distortions, as detailed on page 256, and reality testing had worked well for him, but sometimes he found that saying the same thing over and over again had a comforting quality. We agreed that if it was a positive statement (“I like this jacket. It’s clean, pressed, and it fits well. I’m glad I wore it”), he could repeat twice. Negative statements (“I shouldn’t have worn this jacket. It looks jerky and sloppy”) must be converted to positive statements or worked through on a Thought/Consequence chart.
After a year of work successfully getting rid of old receipts, newspapers, magazines, etc., we still weren’t able to conquer broken toasters. Mr. More and I were reading different scripts. My script sad that each time he accomplished a task things would get easier and easier, until finally the task would present no problem at all and he would simply do it. His script said that one thing had nothing to do with anything else and that each task was as difficult as the last. The lack of visible improvement was disheartening for both of us, but it was important to focus on his accomplishments during the year. The original complaint of spending excessive time obsessing at work was no longer an issue; a secondary problem of lack of social contacts was vastly improved. I had to wonder why it was harder to throw out broken toasters than to risk rejection or humiliation in social interaction. After struggling with the problem in my mind and finding no reasonable solution, I asked Mr. More if he had any insight into it. “It’s not that one is any harder than the other,” he said. “They both seem impossible at the time, but it’s a whole lot more satisfying to be successful socially. Once I throw out the toasters I still have a pile of junk to deal with and it doesn’t seem like I’ve accomplished much for all that suffering.” I should have been able to figure that out. People won’t subject themselves to anguish unless the payoff is substantial. After considerable discussion, we decided to concentrate for the time being on further developing Mr. More’s social skills. Much to my relief, the appointments would take place in my office.
Mr. More’s progress in social matters was already more impressive than I realized. We had been so mired down in trying to deal with the apartment mess that he had neglected to note his accomplishments at work. He had been promoted to a position that would require input at meetings and presentations; he had established two good male friendships; he regularly went out to lunch with other people; he had gone to an office party and enjoyed it; and he was wooing a coworker. The final items was, no doubt, why he had wanted to switch the focus of our work. Mr. More’s concept of romantic technique had been inspired by movies and television. Although he was acutely aware of the fact that he could never pass for Tom Cruise, he did have some very basic misconceptions about the “mating game.” The most troubling of his misconceptions was that if he asked a woman for a date, he would then be committed to go to bed with her; marry her; have a child with her; buy a house; and start commuting to work. So he was extremely reluctant to ask a woman for a date unless he was absolutely sure she was the perfect woman and he was prepared to spend the rest of his life with her.
The object of Mr. More’s attention was a woman in her twenties, recently divorced, and newly employed at his firm. His fear was that he would invite her out and find himself committed to the “whole marriage thing” (as he described it), only to be shocked to discover that she was not the perfect woman for him. We broke the problem down to manageable steps. The first step was to invite the woman out to lunch. That proved to be abruptly devastating–the woman made it clear she already had a boyfriend. A rude fact of life that Mr. More had not taken into consideration was that people may come into his orbit with an agenda that does not include him. For several months our work dealt with his depression and obsessive thoughts of being worthless and hopeless. Then we decided to go back to his apartment and work on the problems of throwing stuff out.
Returning to his apartment a year and a half later was “deja vu all over again.” Maybe my tolerance had lowered, but it seemed to me even worse than it had originally appeared. There was no cleared area where we could sit; paper bags, newspapers, and magazines had reappeared; and it was filthy. A strange thing happened–I lost my temper. “This place is disgusting,” I yelled at him. “Why are you wasting your money with me? You’re not doing anything. I’m not going to sit in this mess while you jerk around with paper bags for another year.”
I have a friend who said that she wished she could live her life on tape. Then every time she made a mistake she could erase that section and re-tape it. Two seconds after I yelled at Mr. More, I truly wished I could retype it. He was shocked; I was shocked. For a while neither of us knew what to do. Finally I suggested that we go to the corner coffee shop and talk about it. He said he thought I was the one person who could understand his problem and accept him; he felt abandoned and betrayed by me. I apologized for my outburst and told him how awful I felt about it and tried to make clear that I accepted his problem and himself as a person while at the same time I found his living style totally unacceptable. It was unfair of me; I was changing the rules. Originally I had been willing to work in his apartment, but then all of the sudden I wasn’t. That session was spent in the coffee shop with him telling me how angry and disappointed he was and that he couldn’t continue our therapy.
A year went by, during which I often thought of Mr. More and wondered how he was doing, before I received a phone call from him. He was seriously dating a woman and wanted to know if I would be willing to work with him in his apartment again. The conditions he set were that I would have to promise not to yell at him, and he would promise to maintain a clean bathroom and clear area for us to sit. I was glad to hear from him again. I felt I had handled the situation badly and left it uncomfortably unfinished. I accepted his conditions and agreed to work with him again.
Mr. More’s current long-term goal was to invite his woman friend to his apartment for dinner. We started, as before, reality testing the importance of wrinkled paper bags, “good” paper bags, old newspapers, magazines. This time the progress was significantly faster. Within two months we were preparing to throw out broken appliances, and a slight improvement in the condition of the apartment was visible. Gradually and carefully he started to throw things out between appointments, and I would arrive to find the piles of rubble reduced and the clear area increased. The kitchen got cleaned; old, dirty dishes were thrown out and replaced by new ones. The floor became visible, scratched tables and broken chairs were thrown out, and new ones took their place. Finally we were able to sit on his couch while we worked on the thoughts, identifying them and reality testing.
This may sound like a miraculous recovery. But in fact Mr. More and I worked together for two years on his problem. During the year that I had not seen him he continued to do the basic work of cause and effecting and reality testing, but he was doing it in the social sphere, which was his original complaint. During those years he learned that the terrible feelings do go away and that the worst never really happens. But most of all, he learned that he could succeed. Once he’d had the experience of success in his social sphere, he had the confidence to seriously attack the collecting problem.
Three and a half years after I had braved my way into the muck and mire, Mr. More invited his fiancée to his apartment for dinner.
(For more information on our work together, see pages 255-62.)
1.) My children, always.
2.) All of my doctors who have helped me throughout this process, former and current, and especially the marvelous Dr. M.
3.) Authors of books, I’ve benefitted so much from reading.
4.) My friends and relatives who have been there for me, and especially my cousin Kathy.
5.) Lady and Pennie, for their love and warmth.