It's Psychosomatic

Literally. His name is Rafa and he’s a 15 month old border collie. Except he doesn’t look much like a collie since he’s mostly black. Rafa likes balls. He really likes them. If a ball is flying, Rafa is close behind. I love Rafa but he can also drive me nuts and make me miserable. He’s not terrifically cooperative. He has his own agenda, and I suspect it usually has to do with balls. I tell Rafa that he’s like a slasher movie. You turn around and he’s there, wielding a ball, although you didn’t hear him come in and you really thought you’d tidied up the balls. Creepy. 

But Rafa is cuddly and waggy so more often than not it’s nice to see him. He always greets me when I come in the door, with the most incredible enthusiasm. Sometimes, quite a bit of the time, he even does what I tell him to and it makes me extremely proud. It is incredible to be able to communicate such a lot with such a different animal. Rafa is funny. He seems to have a knack for comically timed yawns. One of his most comical moments, though, is when he does what the trainer calls “wall of death”. This is when, for no apparent reason, he runs around and around at top speed, practically bouncing off the walls, until he wears himself out and collapses in a doggy heap.

Sometimes I think Rafa and I are remarkably alike. Obsessive and compulsive? Check. For Rafa this must surely centre on balls. Nervous? Check. Rafa is nervous around many things, including backpacks. Allergic? Check. Rafa gets hives like me. Overly health conscious? Check. Rafa doesn’t do rain, if he can help it. Prone to ill health? Check. Thank goodness I live around the corner from a vet. Prone to burning ourselves out through over exertion? Check. Please see “wall of death” above. Bit too smart for our good? (I don’t mean to flatter myself because I don’t really mean this in a good way.) Check. Too often Rafa knows what’s coming next, making it difficult to clean his paws, administer medication and generally do what’s good for him. 

I’m learning about myself through Rafa. For one, I now know about the limitations of my patience but, more interestingly, I think I’m learning about OCD. It has been fascinating to see just how much of Rafa’s behaviour looks like it is purely genetic. Since the age of five months, when I got him, he has developed many identifiably collie behaviours without having had the possibility of learning them from other collies. For example, he often circles the ball instead of retrieving it as though he were rounding up a sheep. It’s amazing to watch. I have much less difficulty in seeing OCD as, to a large extent, hard-wired into my brain from birth having seen Rafa herd imaginary sheep. Secondly, I empathise with my difficulties by empathising with Rafa’s. Sometimes he works himself into a terrible state over kayaks on the canal. He barks and pulls towards them as though he had rabies or something. It takes all my strength to restrain him. I ask him to sit and I see he tries but he can’t. He just can’t. He sits for a second while crying as though in physical pain then jumps up again. I just have to get him out of there. I could cry thinking about him fighting with himself as he tries to do what he knows he should and fails. It’s like me fighting a compulsion.

So, yes. Rafa, or Rafula as we sometimes call him (think Dracula), is creepy, cute and fascinating. I’m so lucky to have him.

This isn’t necessarily an approach I pursue and I sometimes even flagrantly disregard it, but I do find it very interesting. A chronic illness, physical or mental, is commonly thought of as something that requires management. It can’t be cured, so you have to deal with it permanently, and you want to optimise the way you deal with it in order to optimise your quality of life. This is the basic idea as I understand it. That involves different kinds of decisions. For example, in the case of OCD, over the medium term, you might need to decide to pursue a specific treatment plan which combines medication and psychotherapy. Over the long term, you might decide to pursue a career that is minimally stressful. On a day to day basis, you might consciously choose to pace yourself so you don’t become so tired that your symptoms flare up, if your symptoms flare up when you’re tired. As everyone is different, everyone’s management plan will be different. Someone who values their stressful career highly may need to manage their condition through stricter day-to-day management. Someone who doesn’t wish to take medication may need to pursue psychotherapy over a longer period. 

Logical though it sounds, in practice it can be tricky. Managing physical pain is something you do quite instinctively. If your arm hurts when you move it a certain way, you avoid moving it that way and you avoid participating in activities that might call for that arm movement. Mental illnesses, and plenty of physical illnesses, don’t give you that kind of instant feedback to guide your management plan. You have to learn by trial and error what works and what doesn’t and with infinite factors affecting you at any one time, establishing what’s what and achieving that optimal management can take a lifetime or more. You learn gradually how much work you can take on without it leading to a crisis. You learn gradually what signs indicate that a crisis is brewing and alter your how daily management strategies when they arise to avoid reaching that crisis point.

In some ways, the idea of managing a chronic mental illness provokes a bad reaction in me. I have learnt to make last minute decisions according to which way the wind blows and to have faith that what is meant to be will be. I like to live my life that way, even if it often doesn’t work out well. This seems quite incompatible with a sensible management strategy. I also disagree with the idea of accepting that mental illness imposes limitations. I don’t want to mark mental illness out as something special in that sense, because it isn’t. Everybody has limitations of their own and decisions to make with regards to that. However, in the case of non-mental illness, I think many would recognise there is a lot to be said for refusing to accept limitations. On the other hand, perhaps because of OCD, I like the idea of adopting a management strategy as part of my ritualistic ways and so on some level the idea of management also appeals. It promises the kind of routine and protocol that I enjoy working within. If I could adopt management of my condition as a ritualistic thing in a healthy way, that could be quite powerful. 

There should be a conclusion to this but I’m not sure what it is, because I have an internal conflict. The side that is winning out right now is probably the side that thinks management is silly. As I’m feeling reckless, I would rather go with the flow and take the repercussions than be sensible.

From 25mg I have made it up to 100mg. The side effects have generally subsided, except for the dry mouth which is really annoying. I drink a lot of water these days. Today I feel sick again and my heart is beating too fast, but most likely that is because I drank far far far too much coffee. 

I’m not sure whether I have experienced any improvements as far as OCD is concerned, although I suppose I’m not meant to until I reach the 150mg mark that I am aiming for. I don’t think the neuropsychiatrist told me and I doubt the GP would know. I could look it up but I won’t. I suppose I could say that the OCD has changed character to an extent. I have been compelled to tidy and organize more than I have in a long time, although I’m not sure that there is an associated obsession. There has been more washing of hands and some showering at odd hours of the morning due to not wanting to contaminate my bed. But it’s all good. These things are not making me suffer in the least.

I’m not suffering about much because, in fact, I feel extremely happy. I’m really happy with everything. I’m in awe of the world. I want to get paints out and make art in celebration. I don’t know if this is related to the medication. It might be some kind of odd placebo due to my knowledge of the fact that antidepressants can induce mania in people with bipolar disorder. There is no evidence that I have bipolar disorder. There is, however, plenty of evidence that I have OCD which has repeatedly been shown to make me think I have illnesses that I don’t actually have. So there again, it seems that clomipramine is not exactly working, and it also shows what an insidious thing OCD is. 

However, regardless of the reason, I am happy. I’m excited. The world looks full of possibilities. Between volunteering and studying, my days are always interesting and I’m learning. People are nice. They’re cool. They’re interesting. There are so many books to read and I have a kindle and two library cards. My room is clean, tidy, and full of books and stuffed animals. I have a pet dog, complete with paws and a tail. What more could a person want? I hope this feeling lasts.

I have started taking clomipramine as per the recommendation of the neuropsychiatrist.  This is a tricyclic antidepressant that has been around since the sixties and has been extensively tested for treating OCD. My GP wrote the prescription and I’m pleased that this time, unlike with the last antidepressant I was prescribed, I am to see the GP at frequent intervals at first, to see how things are going. I asked whether this was because the side effects of clomipramine are worse than for SSRIs. The GP denied that that was the case, arguing that it all depends on the individual, but Wikipedia confirms my suspicion. 

In fact, having taking two pills so far, my initial experiences have not been the best. As clomipramine acts as a sedative, I was told to take it at night. The first night, I found it hard to get to sleep and I woke up feeling strange. I went to the bathroom and collapsed on the floor feeling as though my blood pressure was ultra low. I was momentarily scared and thought about calling for help but I refrained. After a few minutes, the spell passed and I picked myself up and went back to bed. Later, I was roused from half sleep by nausea and threw up before I could even reach the bathroom. That got rid of the nausea but sleep remained unrefreshing. I was tired the next day and not at all productive. 

Last night I made sure to eat more before I took the pill, figuring an empty stomach could have been to blame, and luckily there was no nausea. However, I still kept waking up, which is unusual for me and which also happened when I was taking venlafaxine. Hopefully with time my sleep will normalize. However, the dose gets bumped up every three to five days and I wonder if side effects will return with each increase.

As the title might suggest, my hands are bleeding. I think this is because I have been washing them too much over the past week. This crept up on me without my realising. I’m not at the stage of washing them multiple times in one go or of washing them again as soon as I turn the tap off because I have touched the contaminated tap etc. but I think I have been washing them when it wasn’t necessary. I have dry skin anyway so the result is a bit dramatic. I now keep my hands curled up because it hurts to straighten my fingers and I also keep them in my sleeves because they look bad. I’m beginning to feel like I have claws. This is not yet a real problem but it needs to be kept in check. Now at least I have understood what is happening so I am prepared to resist and I think I’ll be able to.

Insight is something that OCD sufferers are usually expected to have. The idea is that we are able to recognize that our obsessions and compulsions are irrational, although we may succumb to them anyway. For sufferers who do not appear to have this insight (but not children, I think), diagnosis by the DSM could include the specifier “with poor insight”. This is supposed to be associated with a poorer prognosis. I can understand that, because it is much harder to fight an enemy that you cannot see. Like just about everything, people have come to realize that it is not as simple as either having or not having insight and that, in fact, insight exists on a continuum. 

I think my insight might be moving down that continuum. I asked the neuropsychiatrist why I am having more and more trouble determining what is real and what isn’t. He told me not to read into it, but that it is probably a result of my thinking having become more complex. I’m trying not to read into in a bad way, but I’m still reading into it. I wonder if this is one of the disadvantages (not that I’m suggesting there are advantages) of having grown up with OCD: as I have gotten smarter, so has it, and at every step it has been able to learn how to outsmart me. My OCD brain has become adept at hiding the exit in the personal hell it generates for me on a daily basis, and my healthy brain is struggling more and more to find it.

…continued

I zoned out during a lot of the brain anatomy he explained. I think I picked up on one good bit though, if I understood it correctly. Apparently in solving a problem, one part of the brain is meant to throw forward relevant information to another part to be processed. Apparently, in my case, in the OCD case, that part of the brain doesn’t do it’s job well. It either throws forward too much, including irrelevant stuff, or it throws forward nothing. So either I’m swamped with stuff I can’t process or I get nothing to work with. The problem doesn’t get solved. I think I have read something to this effect before but I had totally forgotten it. 

I might have put my own slant on all this, based on what I wanted to hear, but I hope I didn’t too much. In the end, I left less dissatisfied than I expected, considering that he told me at the beginning of the hour that I was a foregone conclusion. Actually, I left satisfied. I believed him. He seemed to “get it” (which I don’t like to say because of the whiny implication that some people “don’t get it”, but that’s not what I’m going for).

The whole thing has given me so much food for thought about the nature of OCD and there’s now a lot I want to talk about.

…continued

After that, he diagnosed OCD and advocated medication as the only way forward. He was clear, though, that the place to start was specifically clomipramine, a tricyclic antidepressant. According to him, it remains the most effective anti-obsessive drug. I thought it had been superceded by SSRIs but apparently that isn’t so. He had read in my file that I am not keen on medication. Perhaps it was tactical, therefore, that he said that psychotherapy was out. He argued, though, that while he believes in psychotherapy such as CBT, it isn’t useful for cases of OCD that are more than mild. He qualified this and said it could possibly be an “adjunct” later on.

Then I remembered that I really hadn’t waited 5 months just to have the same old diagnosis reconfirmed and the same (or similar) solutions brought forward. So I started pressuring him for explanations for x and y which I seem to have problems with but which don’t seem to be part of OCD. He explained in turn how, in fact, they all are a part of OCD or, I guess, part of the brain dysfunction that causes OCD. Missing things people say: an attentional problem. Being unable to do things like cooking: a problem with task sequencing. A seemingly poor sense of direction: I think he said something about decision making. Apparently all hallmarks of OCD. I wish I could pick his brains all day for explanations. He had them so ready.

To be continued…

I saw a neuropsychiatrist this Friday 13th. Despite the date, I liked him and I think he is the best doctor I have seen. Right off that bat, he told me that he had read my file and that what I am suffering from seemed entirely clear to him but that it was still always good to hear the story from the horse’s mouth.

However, I couldn’t seem to get the story out. I kept starting and stopping and saying that I didn’t know where to start. I really couldn’t figure it out. I was in a new department with a new kind of professional. I wasn’t sure exactly why I was referred there and to him. I didn’t know what he had read in my file. I didn’t know what he was expecting me to say. I started. I stopped. I couldn’t. He said, “Are you generally unable to see the wood for the trees?” I asked what he meant. He said that, as it obviously wasn’t my level of education that left me unable to articulate the story, was it not being able to see the wood for the trees? I agreed that I suppose I am sometimes prone to that. He noted it down. 

He prompted me with some questions, which helped. Much of it was the usual screening but some of it was surprising. For example, “what are the three “symptoms” that you most wish you could change?” had me completely stumped. I went for, getting stuck on things, getting frustrated and missing what’s going on. They aren’t my three worst “symptoms” by a long shot (if they are symptoms of anything at all besides being human) but that was the best I could come up with on the spot. That was what had bugged me the previous day.

To be continued…

I just want you to know, I really hate you. I don’t like to say I hate things but, in your case, at this time, I really do. Please go take a run and jump and leave me alone.

Sincerely,

Ailsa

PS I think it’s actually your fault that you have become personified, so don’t blame me if I hurt your feelings.