One, two, three … One, two, three … Ewa repeated her counting lists several dozen times a day. She was ashamed, so sometimes she was counting in her mind. Mostly, however, she did it aloud. When someone was nearby, she would hide or “dodge”. Because, as she said: mentally, it’s not the same.
– I’ve been counting that way for twenty years. It was an impulse. Sudden and unstoppable. He often appeared at the most unexpected moments. In the toilet, at a meeting, in a church, on the street. If I was sure no one would notice me, I was counting. If someone was there, I would go out for a while, pretend I had to bend down or turn my head and … quickly counted. I was afraid that if I did not do it, I would go crazy – says Ewa.
Ten years ago she went to a psychiatrist. She broke down because she lost her job. She slept until noon. She did not leave the house. She felt worthless. She wanted to beg some medications for sedation from the doctor. To desensitize yourself even more, to forget.
Suddenly, while talking to a psychiatrist, an impulse came. Blood rushed to my head. I pinched my thigh to compensate for my inability to count, but that didn’t help. So I knocked down the handkerchief box and ducked under the desk to pick it up. In the meantime, I counted in a whisper: one, two, three. The relief was immediate. I was able to continue the conversation – says Ewa.
But the doctor heard the countdown. He stopped Eve in his office. After a short persuasion, all red and ashamed, she told him about this “stupid ailment”. That she doesn’t know where she came from. That sometimes it poisons her life and can be tiring. That there are days when the compulsion to count does not allow her to calmly perform the simplest activities. He breaks it even several times – he washes his plate and…. stop… one, two, three. Peels potatoes and melt… one, two, three. He talks to his friend and … pretends to look to the side because you have to count quickly. Mumble even silently: one, two, three, one, two, three … The compulsion is so strong that if he doesn’t count, he can’t think about anything else. Take action.
– Obsessive-compulsive disorder (also called obsessive-compulsive disorder) is characterized by two groups of symptoms: intrusive thoughts (called obsessions) and the need to repeat certain activities and behaviors (this symptom is called compulsions in psychiatry) – explains the psychiatrist, Dr. Maciej Klimarczyk. – In other words, an OCD patient is attacked by repetitive thoughts that he or she does not want to have, treats them as strange, sometimes absurd or embarrassing and tries to get them out of his head, yet these thoughts keep coming back and “tormenting” him. Compulsive behavior, on the other hand, is the compulsion to perform certain activities and rituals, repeating certain words or gestures, which are sometimes so absurd that the patient is ashamed, blamed for them and prefers to treat them as a personal and embarrassing secret. The length of time a patient becomes obsessed and compulsed varies, in the most advanced cases it may even be most of the day. As for the content of obsessions, they can also be different, but most often they concern the control of certain things, checking or cleanliness.
Ewa left the psychiatrist’s stunned. For the first time in her life, she told her honestly what had been bothering her for years. She didn’t get any sedative pills for depression. In their place, the psychiatrist recommended long walks. Instead, she had prescriptions for medications that would ease the sudden compulsion to count over time. The psychiatrist also recommended psychotherapy and gave the address to the psychological clinic. She was supposed to sign up for the first meeting as soon as possible.
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– At first, I was angry with the doctor for treating my depression all the way and focusing on “this nonsense”. I was surprised that this “something” has a disease entity; obsessive-compulsive disorder. It’s good. But I started taking drugs. I’ve always been meticulous. For the first few weeks, I didn’t feel any improvement. I counted as before, and even with even more verve. After about three months, I began to feel something like a slowing down of my reaction. There was an impulse, but I wasn’t responding so violently to it. Yes, I was still able to freeze in half a step, stop the movement of my hand with a spoon wandering into my mouth, suddenly fall silent during the conversation. But after a second or two, the impulse seemed to dissolve. Instead of counting, there was this “eh …” in my head. After that “eh …” the need to count, at least at this point in time, disappeared.
It is relatively easy to diagnose OCD by a psychiatrist who has experience with this type of disease, he explains. Dr. Maciej Klimarczyk. – A careful history should be taken from the patient about the symptoms of the disease and how to deal with them, and certain personality traits should be assessed. People with obsessive compulsive disorder are most often pedantic, perfect, self-controlling people who do not like uncertainty. In situations where the onset of symptoms occurs suddenly and the patient previously did not have the above personality traits, some other cause should be considered. Obsessions can also appear in other diseases as one of the many symptoms. We observe them, for example, in depression or schizophrenia. The entire clinical picture, i.e. all symptoms presented by a given patient, determines the diagnosis.
As for the effects of treatment, they are usually good. Treatment will not completely relieve symptoms in all patients, but in most patients the severity of symptoms is significantly reduced. As I mentioned earlier, people with OCD have personality traits (perfectionism, over-control) – most of them will still have these characteristics, but the most important goal of treatment is to improve functioning. If the patient was not able to function normally before the treatment, and during the treatment he copes with the obsessions he experiences over time, and they do not significantly reduce his comfort of life, the goal is achieved.
Ewa, who considers herself a compulsory and responsible person, did not disregard the psychiatrist’s second recommendation. She signed up for an appointment with a psychotherapist. After a few meetings that were a complete surprise for her, she decided to come to a meeting of a support group for neuroticists. There she met Kamila.
– The psychotherapist’s office is a completely different story – says Ewa. – I had this intention: I will tell the therapist about my problem, we will establish an action plan, and I will adapt. Meanwhile, instead of obsessive-compulsive disorder, for the first eight or ten meetings, I just roared over myself. Throughout my life, I haven’t shed as many tears as I did then. I was talking about a despotic mother, longing for an absent father, a feeling of failure due to the lack of a husband, a great desire for a child, and the therapist listened and listened. It was like a drug. No one has ever listened to me so carefully. I decided that my obsessions are crap, I will not bother with them, that I prefer to say everything that screams in me at least once.
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She said about her obsessions at a support group meeting. The moderator of the meeting advised her to say exactly as much as she wanted. Even if it’s just a sentence. Kamila followed her. I was puzzled when I listened to what he said how obscure compulsive disorder can be for a human being. That mine one, two, three is a piece of cake. Kamila talked about the obsessive blasphemies uttered at every prayer, about the feeling of sin and fall, repeated visits to the exorcist. She revealed that her access routes to the supermarket, work and health center had been developed for a long time in such a way as not to see the church towers and avoid the devotional exhibition. When she accidentally stumbled upon religious symbols, the thought of God immediately flashed through her mind, and then blasphemies raged in her head. To stop it, she had to make the sign of the cross and hit her breast three times. No matter if it’s on the street or in any other public place. That is why in panic she was looking for a gate or an alley, she was rushing to the toilet in a random cafe. If only I could perform my ritual as soon as possible, suppress my terror, feel at least a hint of relief. When she couldn’t hide anywhere, she did it openly and… hated herself for it. Because she was exposed to ridicule or, worse, exposure. That nothing will help her now!
One of the most difficult obsessions for patients are those to hurt someone from the family or obsessive about the religious sphere in believers, e.g. blasphemous thoughts during religious practices – he says Dr. Maciej Klimarczyk. – I think they are the most difficult because they most often evoke deep guilt, low self-esteem or even, in believers, a sense of grave sin. Here I must emphasize that people with obsessive compulsive disorder do not pose any threat and are never put into practice. The essence of the disorder is that the patient finds it unpleasant and unwanted and tries to fight it with obsessions. Imagine a loving mother who is obsessed with stabbing her child. The content of these thoughts terrifies her, and sometimes they become depressed because of it.
The obsessions I have mentioned about harming loved ones are often associated with hiding knives or other dangerous tools, and the compulsions concerning religious content, e.g. with repeated confessions. These behaviors and rituals, although judged by the patients themselves as absurd, are very compulsive. When a patient tries to oppose them, he experiences a very strong fear, so he performs the activity again and again, falling into the trap of neurosis.
Ewa, after more than two years of taking medication and systematic therapy, freed herself from one, two, three. He is still under the care of a psychiatrist and therapist. During the treatment of obsessive compulsive disorder, other problems of the woman were revealed, e.g. a tendency to depressive states and an untreated, deep childhood trauma that inhibited her development and deepened the destructive and debilitating sense of self-worth.
During almost three years of treatment and therapy, I have learned more about myself than in my entire 35-year life – the woman smiles. – There was a moment that I was terrified by this scared, neglected and roaring girl inside me. That I did not want to bring her out to the light of day, show her to the world. That I preferred to hide under the cushion of sadness and apathy, succumb to obsessions and a sense of hopelessness than to go out as I am to people. Now it’s like having myself back. I look at many things differently and accept them. I’m only 35 years old. It occurred to me that I am not worse or different. That a lot of good can happen in my life and what happens is also not bad and unworthy. I’ve also learned to pick up on other forms of compulsions in myself. For example, going back to the beginning of an article while reading, repeating the same line several times during a conversation. In place of one, two, three, “jumps” sometimes spoken, fortunately in the spirit, amen.
Unfortunately, the contact between Kamila and Ewa was cut off.
– At some point, Kamila stopped coming to the group’s meetings – says Ewa. It was rumored that she was going to some exorcist convention. That she was going to move to another city. I really regret that we didn’t exchange our phones. She needed a doctor, not a priest. I think that people still have too little knowledge about neuroses, have no idea where to look for help, and how to help themselves at all.
– If someone suspects obsessive compulsive disorder, he / she should see a psychiatrist. The doctor and the patient will decide on the implementation of the appropriate pharmacological treatment or possibly refer them to a person dealing with psychotherapy – informs Dr. Maciej Klimarczyk. – The obsessive compulsive disorder often has a very large and negative impact on the daily functioning of patients. Imagine that instead of going to work in the morning, we are busy doing certain activities (checking, checking, washing, etc.) over and over again. These people both waste time and bear considerable financial costs. I remember a patient telling me about his enormous water bills due to having to take a certain bath for more than two hours a day. Another patient, who is a teacher, said that when checking the class work of her students, she sometimes lost a few nights due to compulsive repetition of this activity. Imagine the families of sick people who often do not understand their problem and have to adapt somehow. However, I believe the greatest cost is the emotional cost. People with OCD suffer greatly from their condition. They are aware that the thoughts in their head are absurd, and at the same time trying to oppose them causes so much effort and fear. More than half of people with obsessive compulsive disorder develop symptoms of depression.
Unfortunately, sometimes there are very resistant cases of the disease, where the severity of symptoms does not decrease despite pharmacotherapy and psychotherapy. Then, the ultimate method may be neurosurgery, which involves cutting some brain connections. However, since it is a very traumatic method, with potentially serious side effects and sometimes also not bringing the expected results, it should be reserved only for the most severely ill, after all other treatments have been exhausted. That is why it is performed very rarely.
Most patients are treated with medications and psychotherapy (the so-called cognitive-behavioral psychotherapy). A certain group of antidepressants (so-called SSRIs – selective serotonin reuptake inhibitors) are most often used for treatment, because they have a very good anti-obsession effect. During psychotherapy, we try to train the patient’s ability to cope with the compulsion of rituals, leading to their gradual reduction and at the same time observing the effects of this. Most often, patients fear that abandoning the ritual will lead them to a “catastrophe” (examples: not washing your hands – illness: not checking the gas repeatedly – fire: not hiding the knives – harm done to others, etc.). It turns out that the effect is quite the opposite – the sense of freedom increases, the anxiety decreases and the catastrophe does not come. We are also working on an appropriate approach to our own obsessions. I always try to explain to patients that the content of their obsession does not reflect them as people, but a certain disorder in the brain’s “contacts”, and we have no influence on it. Fighting unnecessary guilt is very important and very helpful in these situations.
Post scriptum
Ewa is no longer alone. She gets married in August. She is expecting a baby. In the throes of the pre-wedding preparations, compulsions appeared. Unfortunately, due to her pregnancy, she cannot take medications. She still manages to stop her from counting, but she repeats the “amen” sometimes several times a day. He tries not to worry about it. After giving birth, she will take pills again. She started doing yoga. Claims it helps a little.
Text: Joanna Weyna Szczepańska
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