Oh, The Controversy! That’s Not Me, That’s My OCD

A common approach to the treatment of OCD is to encourage externalizing of the disorder and attributing unwanted thoughts to this external source. This can be particularly effective for children, who may not have the cognitive abilities to make abstract distinctions between one’s self and one’s thoughts or feelings. The idea of relabeling thoughts as “OCD thoughts” was popularized by the groundbreaking book Brain Lock by Jeffrey Schwartz. Though this book offers an excellent comprehensive look at the way OCD operates in the brain, as well as a treatment approach that many have found useful, I believe the act of labeling one’s thoughts as “OCD thoughts” and attributing their existence exclusively to the disorder may be inherently problematic for many OCD sufferers. If we want to make a clear distinction between a thought and the identity of the person having it, we are better off viewing all thoughts as thoughts, rather than attributing some to a disorder and some to an identity. The question is, how can we view our most challenging or disturbing thoughts as our own without getting caught up in false beliefs about who we are as people? Here I think we can benefit from distinguishing between content and process.

Content vs Process

Content refers to the words and images that make up your thoughts. If you could print the thought out and look at it as a series of words, what would those words be? Mindfulness, the ability to observe internal experiences without judgment, very much asks us to do just this, to look at our thoughts as we look at words on a page. The content of the thought is merely what the thought is comprised of, like ingredients are the content of a soup.

Process, on the other hand, refers to how we taste, experience, and think about the soup and the chef who made it. One person may say the soup is delicious and applaud the chef and another may say the soup is disgusting and admonish the chef, but this is independent from the veracity of whether the soup contains carrots. People with OCD may be predisposed to perceive certain thoughts as threats, mandates to do compulsions, or evidence that they have done something wrong. Someone without OCD might take the same thought content and process it as meaningless background chatter or junk mail. In other words, OCD sufferers process their experiences in an OCD way, but the content itself is not unique to the disorder.

Let’s look at some examples. I happen to be writing this blog while on an airplane. “Airplanes are busses with wings and full of germs, which can spread disease.” What is this? It is a thought. What else can we say about it? Well, it may be true, it may be an opinion, it may be a cynical way of looking at a situation. Is it an “OCD” thought? If you have contamination OCD, you might assume so. You might figure no one would think such a thing if they didn’t have OCD. But nothing in the thought itself is all that controversial or even interesting. Now let’s add a process to it. Imagine taking the thought and integrating it with another thought like, “I have to make sure I don’t touch anything and I must use hand sanitizer regularly.” Now the content of “germs” takes on a value. Consider that another way of processing the same content could be “Well, so be it, but at least I get to travel and that’s awesome.” What if we further built on the first process by adding anxiety, self-criticism, increased heart rate, shortness of breath and a powerful urge to check, avoid and wash? Sound familiar? That’s OCD! So here saying, “That’s my OCD” may actually be really helpful because it may lead to a change away from compulsive behavior. “That’s OCD junk and I’m better off leaving it alone. Let’s see what the in-flight movie options are.” The thought about planes being germy is not “OCD” but the processing of that thought towards compulsive behavior is.

Another example, picture yourself standing on a train platform. In front of you is a child and you think, “I’d enjoy pushing that child off the platform and watching it get hit by a train.” Now, presuming you don’t have an illustrious history of murdering people, you might find this thought pretty disturbing. It represents pretty much the opposite of your identity. What is the content? The content is the idea of pushing a child to his/her death. Who thought it? You did (literally, you the reader just thought it too). Now, what is the process? Well, you could process the thought in an OCD way and say something like, “I shouldn’t have had that thought. Only horrible people think that way. I have to back away from the child because I must be some kind of a sicko and it would be immoral to ignore this horrible thought.” Or you could process it in a healthy way, as in, “Well, that’s creative.”

Owning Your Thoughts

So what’s the real problem with just calling all thoughts with the word “germs” or “death” in it “OCD thoughts”? The problem lies in the dis-ownership of thoughts. And yes, this applies equally to thoughts like “I want to have sex with an animal” or “I love Satan” or “I’m in denial about loving my wife” or “I may have touched someone inappropriately and not remember” or “I may never stop thinking about blinking” and so on… Owning your thoughts does not mean assuming the thoughts are a reflection of your identity. Owning your thoughts simply means accepting that these are the thoughts going on in your head. Perhaps you process these thoughts in an “OCD way” (i.e. you take them too seriously and assume they deserve urgent responses) and in that case, it’s fine to say that it’s your OCD that’s upsetting you. But the thought itself is not an “OCD thought.” The thought itself is simply a thought. If your first response to any thought is to disown it (i.e. “that’s not my thought”), then you are starting off be framing your thought as a threat and this is what kicks off the obsessive-compulsive loop. There is nothing to disown. It’s just what you happened to notice going on in the mind. If you want thoughts to stop being intrusive, you have to stop treating them like they are intruders. If you want them to come and go with ease, you have to allow them free passage.

The OCD sufferer is a noticer, a person who notices things that others overlook. It is a gift when it comes to noticing greatness in music or art, when noticing the little things that make our loved ones so lovable, or noticing the revealing details in complex problems that we solve at work. It is a burden when noticing that someone touched their nose before shaking our hand, or noticing that one mistake on the road could lead to a terrible accident, or noticing that we can’t remember with perfect certainty where we were an hour ago and might have done something shameful. But the point is we notice our thoughts, the delightful ones and the sinister ones, and they are undeniable ours to notice. If we attribute their mere existence to a mental disorder, we tell ourselves a lie about the nature of thoughts, and that puts us at a disadvantage when fighting the disorder. Plus we open ourselves up to so much unnecessary self-criticism for having too many “OCD thoughts” and not enough “good” thoughts of our own.

If I stand at a window, I am likely to notice a thought about jumping out of it. These are my thoughts. That is how I think. And the less I mind this, the more open and available I am to the arrival of thoughts about the beauty of the sunset outside that window. Mindfulness is not minding. But if I begin to worry about why I had these thoughts and whether they will lead to horrific ends, then that is my OCD and that is what I would want to change. Developing mastery over OCD is all about learning to love having a mind like an hd 3d imax screen, full of texture and color, regardless of what is being projected on it. By owning all of our thoughts, we are then free to disown the mental rituals and other compulsions that cause us to suffer. That’s not you. That’s your OCD.

Jon Hershfield is the Director of The OCD and Anxiety Center of Greater Baltimore and a specialist in the treatment of OCD and related disorders. He has previous experience as the Associate Director of the UCLA Pediatric OCD Intensive Outpatient Program and as a Psychotherapist for the OCD Center of Los Angeles. You can read more from Jon here.