Dealing with mental illness is not for sissies.
So many of our poor kids have OCD. What a horrible brain glitch! Repetitive thoughts (the obsessions) and actions (the compulsions) that go round and round, and erupt into violence at times when you as a parent have to block a dysfunctional compulsion.
Peter’s OCD cycles up and down. Right now we are in a fierce upswing in the frequency , intensity, and sheer variety of compulsions. As soon as we tackle one and face it down, another pops into its place. As Peter puts it, “They are popping up like daisies!” But ferocious daisies.
Meds can take the edge off, at least temporarily. But meds frequently aren’t enough. Peter and I put on our armor of psychological tools to do battle with OCD daily. The following example from this morning illustrates the major ones we use, CBT (cognitive behavioral therapy), shifting attention, and delay.
No sooner had I walked into Peter’s room than OCD greeted me at the door.
“Good morning, Peter,” I said cheerfully.
Peter’s eyes flew open. He sat up in bed and grabbed my wrist, drawing me in close as I sat by the side of his bed.
“Pink goggles,” he said, eyes wide and staring into my face.
I sighed. For weeks off and on, Peter had been holding on to an old pair of pink swim goggles that he would tap incessantly. I had relocated them earlier in the bathroom as an incentive to get him out of bed and into the bathroom. “Wow. Looks like you really want those goggles. You seem really anxious to have them right away. Now think about it, Peter. Is it reasonable to feel so driven about a pair of goggles, or is this an OCD?”
“OCD,” said Peter, still gripping my wrist.
“Well, if it’s OCD, let’s not just give in to it. The OCD is saying you have to have those goggles right now or die. But you know you’ve lived many years just fine without holding onto them every moment. So how about teaching your OCD a lesson? I put your pink goggles in the bathroom. You can either turn OCD into a reward to help you get out of bed and into the bathroom where they’re waiting for you, or try to ride the wave till it diminishes. Hey, I wanted to talk to you about that great show we saw this weekend in Vegas with Cirque du Soleil and all the divers.”
“Pink goggles,” said Peter. I could feel the heat on his emotional thermometer rise.
“Come on, you can do this. Shift your attention and type with me. Remember, you have access to those goggles any time you want. They are a short walk over to the bathroom, and you can go get them any time, no problem.” As I reassured him about access, Peter’s face and grip relaxed. He sank back into his pillow. The rest of the conversation went as follows:
Mom: So did you like the clowns at “O” (the name of the Cirque du Soleil show)?
Peter: Yes. The little one was cute. I liked his sounds. His body movements were ingenious.
Mom: I agree. I especially liked their first act on the sunken houseboat. What was the storyline?
Peter: The little clown used a big hammer to (knock himself out to) fall asleep. The big clown lost control (of the hammer) and made a hole in the boat (which spouted a fountain of water gushing up into the air).Then they sat in the undersized bed together and shared the umbrella with holes.
Mom: Did you get the joke about the grandfather clock?
Peter: Yes, it was a bathroom.
Mom: Peter, you are good at reading body language. Isn’t it amazing how without any words used, the clowns communicated an entire story so well?
Mom: I thought the ending was bittersweet.
Peter: The clowns showed that we go through life solving problems in silly ways that cause more harm than good, but at least we can love each other.
Mom: Beautifully put, my dear. Very true, actually. Peter, did you notice, how the OCD wave passed you by as you redirected your attention?
Peter: You are right! I guess you appraised the situation well. I feel strong, not a slave to the OCD.
So what were we doing? The overall strategy was CBT, or cognitive behavioral therapy. The basic steps of CBT are to identify or label what’s going on, then identify the false thought, replace it with more realistic thinking, and problem solve how to proceed. So we identified the request for pink goggles as an OCD. We replaced the false thought of “goggles now or die” with a reminder of his own experience of having survived successfully without them for most of his life. Then I offered him a choice of alternative ways to deal with the OCD rather than giving in to it. Peter seemed very agitated about any thought of not getting the goggles, so I reminded him that access was possible and in his control at any time if he just made the effort to get out of bed.
That reassurance was enough to dampen the fire of the OCD drive enough to allow his upper brain to engage with me. Indeed, that is why delay is the number one most useful tactic in dealing with OCD; if there’s an end in sight to the misery of not getting to do the compulsion, the amygdala seems to immediately cool down a notch.
Then we embarked on engaging that wonderful frontal lobe, master of illusion and distraction. I chose a subject that was fun and interesting, a circus act we had recently watched. You want to ask questions that engage the mind, but are not too hard, especially at first when the child already has his “affective filters” up (meaning already upset, and therefore not thinking at his best). So I asked Peter for a summary of the action, which for him, is a pretty easy question. Once we got into the conversation, I made a more challenging comment (“the ending was bittersweet”) to really fully engage the frontal lobe and give him something more provocative to get into. Peter’s answer was indeed beautiful, not only because of his insight, but because delving deep into his thoughts and feelings reconnected his upper and lower brain, and freed him from the grip of the OCD.
We were lucky. This time the obsessional wave actually passed him by and completely left him for a time. It’s not always so neat. Many a time the OCD is too big, circumstances are such that I cannot grant even partial access, and a meltdown ensues. However, my point is that if you just keep working on your tools of CBT, attention shifting, and delay, you will have successes like this. Starting with the smaller OCD’s. As the frontal lobe connections get stronger and the OCD circuits get more and more starved of practice, the hope is of building a stronger fighter and weaker OCD monster. Time and practice will tell.