“Neither defiance nor denial is of the least use here: one takes arms by learning how to negotiate or navigate a sea of troubles, by becoming a mariner in the seas of one’s self.” Oliver Sacks, 1990
Peter was struggling this weekend. Couldn’t be left alone a second or would tear something up. Took out the sole of his shoe and ripped it into pieces in the time it took me to get to the kitchen and back. Repetitively rifling through his basket of scrap paper he was allowed to tear. One of those days Peter was definitely uncomfortable living in his body. So we had to get out. “Carride, airplane!” Peter said over and over. We set out looking for any kind of change, doing something or being somewhere Peter could find calm in the storm.
Papa drove us to Descanso Gardens. Peter immediately started hunting for sticks, one after another, each of which he peeled and broke into bits. I asked for a map at the entrance (Peter likes maps, and they’re organizing), and struck a deal. “Ok, Peter, let’s try to get a grip on this tearing things up compulsion. Let’s exercise that frontal lobe inhibition and get you back in control.” “Okay, okay,” said Peter, still furiously dissecting a foot long branch he picked up at the entrance. “So here’s the map. You pick 5 places to go, and we’ll trace our way to each place on the map and then find a bench there. Make a comment on the scenery, earn a stick. No sticks in between. Sound like you can do it?” “Okay, okay.”
I stuck my finger at the entrance where we were, and Peter decided where to go. Getting to the first bench stop was the hardest. Peter was dying to pick up a stick, so we made the first distance very short. “Hold on Peter! First the comments.” I closed my eyes. “I feel a soft breeze.” Papa said, “I see the tall sycamores.” Peter typed, “I hear the water.” Then he made a dash for a stick. But gradually, as we made our way, progressing from bench stop to bench stop, the peaceful garden worked its quieting peace upon Peter. The rests became longer, the drive for the sticks less immediate. Peter’s comments grew more elaborate. I ran a soft fern over one hand and had him feel the rough bench with the other. “I feel a soft fern and a hard bench.” “I see a big pile of rocks stacked.” Then wow! “I see a green wall of branches.” Peter was waxing poetic!
By the time we finished our last comment, the restless drive of that lower brain had been tamed by exercise of the body and mind in contemplation of the beauty of the garden. It’s loveliness and serenity for a time cast a spell over the mental monsters that plague Peter. This time the monsters had not won. Peter had ridden the storm of his tearing compulsion by confining it to a small place in a larger schedule, purposefully replacing it with other thoughts, turning his attention to the beauty surrounding him. For now the wave had passed, and we all felt refreshed and renewed, with hope in the power of mindful contemplation.
I exchanged glances with my tempest-tossed son, now at peace. “So who’s in control now, Peter or OCD?” “Peter,” he said with a smile. “All right, buddy! Give me that high five. You’re getting stronger, and the OCD’s getting weaker. And the doctor promised the more we practice, the easier it’ll get.”*
* So how does one work on OCD? What did the doctor mean by practicing? Basically she meant the more Peter resists carrying out his compulsions until the obsessions pass, the more he experiences success in “riding the wave,” the more he’ll realize he does NOT have to obey the obsessions. It’s best to work on this in conjunction with a formal exposure/response prevention program, in which you practice regularly under more controlled, less intense conditions.
You and your child need to first be able to identify the enemy, to recognize that it’s the OCD, not the child himself, who is the problem. OCD is a problem the child has, but can choose to work on and diminish to manageable proportions.
You explain how OCD is a brain miswire that makes you feel anxious unless you do something that doesn’t make sense or may be actually harmful. The child has to understand that the way to make the OCD weaker and for him to regain control, he needs to resist doing the compulsion (the dysfunctional behavior that the OCD is telling him he must do), and the need/desire to do it will diminish and eventually pass like an ocean wave that comes and goes.
It’s very hard to resist initially, but with each time you do, it gets easier and easier. With really strong OCD’s, you can’t just tell yourself “no.” Sometimes the best you can do is just somehow modify it, by engaging in it a shorter amount of time or repetitions (set the timer and tear up sticks for just 1 minute instead of 5), delaying when you allow yourself to do it (do the dishes before you get to grab a stick, or walk a block first), or changing up the way you carry it out (play a clicking sticks together pattern together with the parent before you get to tear it up). Peter’s favorite strategy is to “trick” the OCD by creating a whole schedule of things he has to do before he gets to do the compulsion, and by then often the need to do it has passed, and he doesn’t ever have to obey it at all.
Then you and your child make a list of OCD’s and start working on one at a time, usually starting with the less intense ones so the child experiences success which encourages him to keep moving up the list. But it’s most important for the child to have a lot of input into what he chooses to work on, and what’s most meaningful to him. This is critical for two reasons. One obviously is motivation. But the other is that we parents can have a hard time distinguishing between dysfunctional obsessional perseverative behavior and perseverative behaviors that may be serving as useful sensory accommodations for your child. For example, flapping and tapping may be a child’s way of figuring out where he is in space, and unilaterally insisting that a child stop it may leave him with overwhelming feelings of disorientation which could make meltdowns inevitable.
Say your child chooses to work on a compulsion to tear off branches from bushes he passes. You might decide to start with setting the timer for 5 minutes he has to wait before tearing off a branch while gardening outside and pulling weeds or harvesting vegetables (and/or doing deep breathing exercises) instead. (It often helps to initially pick a substitute activity that physically exercises the body and/or one that keeps the hands busy such that doing the activity is incompatible with doing the compulsion. Eventually you want to work on helping your child learn to become aware of other interests and ideas he may have, and help him learn how to turn his attention to a different one of his choice. That is working on building what’s called “mindfulness.”) You gradually increase the timer till the child loses that crazed urge everytime he steps outside. You and your child agree to work as a team to strengthen his control over his OCD by deliberate practice, with you there to help keep him regulated with your calm redirection.
Your child works on his pre-planned “OCD homework” every day, working up to say up to 1/2 an hour twice a day (see John March’s excellent manual for parents and kids called, “Talking Back to OCD”), strengthening those frontal lobe inhibitions and basal ganglion “stop!” signal, while diminishing those OCD circuits by decreasing their use. Setbacks are normal and expected, so don’t let them upset you. You and your child can expect that if he gets up again, doesn’t give up and keeps trying, with consistent practice he will get gradually and eventually get more and more in control, and the OCD less. It’s important to realize that OCD is a condition one has, like diabetes, that seldom completely goes away, but can be managed successfully with consistent vigilance and habitual effort, such that a functional, fulfilling life is possible. It’s just necessary to make and take the time to deal with it.