"Intrusive thoughts are a mark of obsessive-compulsive disorder." Photo: Stocksy
It didn't matter what we officially called it, my psychiatrist said as he looked up from his notepad. What I had was "worry in search of a mission".
Within 40 minutes of speaking with me, he'd learned enough to accurately describe the private struggle that had defined my life. Technically, there were names for what I had, at least according to the Diagnostic and Statistical Manual of Mental Disorders: obsessive-compulsive disorder and generalised anxiety disorder. But, as my psychiatrist told me, these labels were most helpful for research purposes. You could, he said, drive a truck through psychiatric diagnoses. And, throughout the stages of an individual's life, the diagnosis can change.
My anxiety started when I was in third grade. I stood alone at the bus stop with a battery-powered travel alarm and two watches. I checked them frequently as I looked for the yellow bus to appear, fearing it never would. My teacher called me a worrywart and my parents thought I was eccentric. No one thought I needed help.
When I was older, AIDS snatched the life of a beloved teacher, and I privately feared disease and death could jump out from the dark. Instead, it was two men with a gun on a lonely subway, a mugging that made me susceptible to panic attacks in tunnels and dark theatres.
There were other moments that convinced me that life could suddenly go from safe to dangerous. That sunny day at work in September 2001, for one, when I watched the planes hit the towers and thought about the split-second decision I made earlier to not head downtown and vote.
But I didn't need the prospect of large-scale terrorism to drive me into obsessive worry. No, I could find the possibility of disaster in much smaller moments: Was a fever a sign of meningitis? Did the pharmacist give me the wrong medication? Did I hit someone while daydreaming as I drove home and somehow not even notice?
Such intrusive thoughts are a mark of obsessive-compulsive disorder. It was after a doctor discovered a blue and green mole during an annual pelvic exam that I began to exhibit the other classic trait of OCD: repeated actions. For me, this meant checking my skin for signs of trouble. I'd check. I'd ask my husband to check. I'd go to dermatologists to check. And then I'd do it all over again. At my peak, I went to three dermatologists four times a year, convinced that each of them had failed to spot a lurking cancer. Between visits, I was absorbed in what-ifs, and I was never without worry.
If I had already been slowly succumbing to anxiety's hold, my decline gained speed after I was mugged at gunpoint on the way home from an acting class. I immediately signed up for a course in self-defense, and then several in journalism. I said goodbye to theatre and hello to a job in news.
There were other changes in vocation and in how I managed my anxiety. Some might be attributed to factors that influence many people's lives: marriage, children, moves and an attempt to be flexible. I switched to teaching, and eventually to writing. And in many ways, I was always normal enough. I could leave the house, do my work, care for my children and socialise with friends. But my worries were never put to rest, and in my mind they were always justified.
It was my husband, a calm and steady guy, who finally said he wasn't going to put up with my need for constant reassurance. And most of all, he didn't want the kids to grow up in an environment of anxiety. Fortunately, I realised that if my private torture was now affecting my husband and potentially my children, I needed real help. And I needed to make progress.
The doctor I saw knew his stuff. And he was precise. This was not about talking it out or unravelling my childhood. This was about brain chemistry. He ordered a blood test to check my liver and thyroid, a precaution he takes before prescribing medication. He started me on a small dose of an antidepressant commonly prescribed for depression and for anxiety. We scheduled a phone call to check in within a week, and follow-up appointments for the next month and beyond. Meanwhile, I would meet with the psychiatrist's colleague, a social worker who would offer cognitive and behavioral strategies.
This combination of medication and cognitive behaviour therapy is the best treatment for OCD, according to clinical psychologist Felix Vincenz, an expert in the field and associate director of the Missouri Institute of Mental Health. Through this process of letting go of my compulsive behaviour, I learned that nothing terrible happened as a consequence. I learned to interrupt the impulse to cover up and to check my skin and have a doctor check it.
Things improved quickly. After about a month, I had the feeling that the elevator in my mind, the one that used to shoot to the top floor of anxiety with the slightest provocation, now hovered somewhere in the middle. I was more able to live in the present moment instead of being tangled up in thoughts about death or disaster or failure.
I credit my husband for his tough love; my psychiatrist and social worker for their comprehensive care; and the friend who had been through hell and back with her husband for giving me blunt advice. And I look at my family history and the choices not taken because of anxiety, and I feel fortunate that I live in this moment, when the suffering might be eased with less stigma, more-appropriate medication and an awareness of lifestyle changes that can support progress. It is embarrassing to share my private struggle, but not so embarrassing that I don't want someone else to learn from it that there are ways to ease the burden of anxiety and OCD.
I will admit that new fears creep in, especially recently. But I am aware of my tendency for catastrophic thinking and for channelling a worry into a compulsion. I don't want to go there again. I know now that there is an alternative.
A few months into the therapy, we packed up the car and pulled out of the driveway to set off on a 1500-kilometre drive. My husband turned to me and said "That was the first time since we've been married that you didn't get upset about how I loaded the car."
You see, it was never about the car.
Or the stove.
Or the mole.
But it was always about letting go.
Vander Schaaff is a freelance writer. She wrote this for The Washington Post.