Because We Are Bad Page 8

  “I’m going to draw it for you.”

  She draws a line that wiggles up and down like a snake.

  “This is what happens when you do a compulsion. Your anxiety initially goes down, but very soon after, it rockets back up again. So then you do another compulsion to get it back down, but then bam, more obsessions, and it goes back up. You get the idea.”

  She draws another line. At first, this one goes higher than the first line, but then it gradually starts going down again, until it’s lower than the lowest point on the first line.

  “And this is what happens when you resist a compulsion. Initially, your anxiety soars higher than it would if you just did the compulsion. But then over time it comes back down to base level and eventually goes lower than it would by doing a compulsion. And because you’re resisting the compulsions, it doesn’t go back up.”

  “So what you’re saying is that if I don’t want to feel so bad, I shouldn’t record the words and analyze them? I shouldn’t react to them when they pop into my head?”

  “Yes. That is exactly what I’m saying.”

  This thought is as startling as a bullet hitting me from behind.

  “How would you feel about taking medication?”

  We are prescribed fluoxetine: Prozac. We had no idea Prozac was used to treat anything apart from depression, but it turns out it is also used for people with OCD. Our dose will go up every few weeks, and eventually we will be taking about three times as much as someone with depression.

  Fluoxetine is dispensed to the school, and we pick it up from the med center. In the nurses’ office, Tess squints over her glasses and hands us the pills, pinching her lips into a prune. We can tell she is itching to ask “What fucked you up, then? Look at this lovely school you go to. What gives you the right to be unhappy?”

  At first, we don’t notice much. But after a few weeks, the pills make us tired and groggy. I start to care less about everything. Friends, family, and, crucially, routines.

  She is calling for me to engage with her, but She feels distant, like a voice echoing from the top of a wooded hill. I try to keep up with the routines but cannot muster the mental energy to do as much in-depth analysis with her.

  Our memory also seems to be worsening. Occasionally letters slip away, or the letter is remembered but not the accompanying word. We’ve started writing the letters on our skin so they are not forgotten. They wind their way around our left hand and down our fingers, before crawling up our arm like spiders.

  She stomps around. She is cranky and bitchy.

  She moans:

  You’re killing me. After all I’ve done for you. You’re poisoning me with those little orange and green pills. You could hang me, but you don’t have the guts. So instead you’ve opted for a long and drawn-out death.

  Well, fine. Have it your way.

  But I won’t go quietly.

  · 14 ·

  Pills, Pills, Pills

  It turns out that having a friend is uncommon.

  “But then,” says Dr. Finch, “some people do say they hear their OCD as a voice. . . . It’s difficult to know exactly how someone’s OCD feels unless you’re actually in their head. It could be because you had OCD from when you were so young that it was just easier for you to see it that way.”

  She wants to discuss the obsession about being a bad person.

  “We’re going to look at something called Theory A and Theory B. I’ll draw it for you.”

  She writes Theory A in the first of two columns and Theory B in the second. She writes a message under each heading and hands us the paper. Her writing is thin and messy.

  “Which do you think you are?” asks Dr. Finch.

  “Theory A.”

  Theory A is:

  I am a bad person, and I must do everything possible to record everything bad that I do.

  Theory B is:

  The problem is not that I am a bad person, but that I am excessively worried about being a bad person.

  “Okay. Well, in order to get you better, we need to do CBT, cognitive behavioral therapy. In OCD, a key element of CBT is exposure and response prevention, known as exposure therapy.

  “You’re going to have to repeatedly sit with your obsessions without doing a compulsion—putting them on your list and analyzing them to make them go away.

  “Over time, practicing this healthy behavior is going to make it automatic. Because your compulsions take up so much of your day, you’re going to be doing constant exposure therapy.”

  So I try acting like Theory B is right. When I accidentally glance at the body of a girl in a lower grade, I attempt to act as though the problem is not that someone will think I am a pervert, the problem is that I worry too much that someone will think I am a pervert.

  When our tummy rumbles or I end up scratching our nose without thinking about it, I try to believe that I am not disgusting and everyone knows it, I am just worrying too much about ordinary things.

  I try to let letters come—and not respond to them.

  TOILET: We came out the toilet, and Ellie was waiting outside the door to use it. We’d only done a pee, but suddenly we felt like we had done a huge shit and it was all over the whole toilet, the walls and the floor. We needed to go back and check. We couldn’t do that because that would look weird. We froze. Ellie raised an eyebrow. Did this whole interaction look odd? Was there actually shit everywhere?

  Don’t respond to it. Don’t engage with it. Ignore the letter—

  And guess what? I can’t. None of it.

  Can’t do it. Won’t do it.

  Dr. Finch is not disappointed. I tell her there has probably been about a 5 percent improvement, but that I think it is mostly down to the medication, because I haven’t been very successful at resisting doing the compulsions.

  “That’s okay,” she says. “It’s not going to happen overnight. And five percent is a great start, since you’ve only been coming to see me for a few weeks. I feel quite positive about five percent.”

  She parrots in a baby voice:

  “A great start! I feel quite positive! Go get ’em! Everyone’s a winner! Psychiatry rocks!”

  I stifle a laugh.

  “Sometimes I feel like there’s two people in the room sitting opposite me,” Dr. Finch says, “having a conversation about me, and I have absolutely no idea what they are saying.”

  Dr. Finch gives me homework, and I have to report back to her when I next see her. This week I am supposed to interrupt our routines, and keep doing it until I can’t remember them anymore. This means every time we find a Pause and start doing a routine, I should snap out of it and do something else instead.

  “Your routines feed off isolation,” says Dr. Finch. “During breaks, when you would usually go back to your dorm and lie on your bed to do routines, have a break. Go to the canteen, get a cup of tea, sit with your friends.

  “Even if you’re not actively chatting, just being there takes you away from all that time in your room on your own. If it’s the evening and you’re sitting in your room by yourself doing routines, go and knock on Scarlett’s door. You’ve told me before how close you are. I’m sure she would want to help.”

  So far, Dr. Finch has only given me one task per week, but this week she sets two. For the second, we talk about the way everything is done in threes. Hand washing, light switches, and locking doors are the visible tip of an otherwise fully submerged iceberg. Tap, invert, sleeves, and hair are noticeable, but only to an attuned eye. The rest, the rhythmic repetition of letters, thoughts, and actions . . . how could anyone guess?

  Dr. Finch asks which of these things would be hardest to give up. I tell her: thoughts. Not that the others will be easy.

  “Okay,” she starts. “We’re going to do graded exposure. We’ll start with whatever you find least intimidating and work our way up to the hardest. So the physical things. Because we need to do something about those hands.”

  I look at my lap.

  My sleeves are pulled
down as far as possible to cover my hands, but the knuckles are visible. Red and scaly, rippling like the back of a Chinese dragon. Peeling, scabby.

  Raw to the bone.

  I don’t think about them too much. In the back of my mind, I am aware that they are very painful when they are moved or brushed against, like they have been held forcibly over a fire, but She turns the discomfort down like a dimmer switch.

  Dr. Finch wonders how many times a day I’m washing them.

  “About fifty.”

  “And every time you wash them, you do it three times? With three lots of soap?”

  “Yes.”

  At what point did all this start?

  We think it was the advert on TV for antibacterial sprays and soaps where dirt is seen in ultraviolet light, infecting everywhere.

  I kill 99.9 percent of dirt! Buy me!

  But what about the 0.01 percent? we are screaming.

  What about the 0.01 percent?

  Or the things Mum and Dad told us—germs are bad, sometimes you can’t see them, bacteria spreads disease; remember cleanliness. The things all parents say.

  The things they said to protect us. The things I let my friend take too far.

  “Okay. So if we could get you only washing them once each time, that’s already a lot less. Let’s do an exposure.”

  Dr. Finch leads us to the bathroom down the hall. Under her instruction, we turn on the tap and wash our hands once. Knowing we are not going to do it twice more makes our heart catch and beat faster; we feel like we are burning from the inside out.

  My friend reasons that this is just a stupid experiment, and it doesn’t have to count if we don’t want it to. We take three paper towels from the dispenser, using one to turn the tap off (so we don’t have to touch it with our 33.33 percent recurring clean hands) and the other two to dry our hands. Dr. Finch notices and says “Mess it up. Take another one.”

  “What?”

  “Feel uncomfortable with the number. Take four paper towels.”

  “But that’s even more?”

  “When we’re doing exposure about numbers, it’s so ingrained that sometimes you’re going to do stuff in threes without even thinking. When that happens, it’s easy to say ‘Oh, I’ve failed, never mind,’ but actually there’s still the opportunity to do an exposure by just going a number higher: it’s still the ‘wrong’ number of times, right? I’m using this opportunity to show you how to do it.”

  We’re not paying attention. We are busy thinking.

  One soap squirt + four paper towels = five.

  Five is a bad number, and we don’t like it one bit.

  I write notes in a little blue book with spirals on the front.

  SUCCESSES:

  I went to first break four out of five times this week. People were talking, so I couldn’t review routines, and full review was put off until lunchtime, when I went back to my dorm. Along the way, so much piled up that I forgot what some letters stood for. I haven’t managed to retrieve them.

  On Friday, Ellie came into my dorm at lunch and started an in-depth dissection of the character flaws of her boyfriend Ben. She stayed for forty-five minutes, until it was time for class. We walked to the main building together. About 20 percent of the letters slipped away.

  I have switched off lights and plugs only once, but I am so used to doing everything in threes that I usually forget at first and have to go up to a higher number like four or five.

  The same goes for passing my hand under taps in multiples of three to check that I can’t feel water coming out and that my eyes aren’t deceiving me.

  When I wash my hands only once, She tells me that I will have dirty smears left on my fingers, which I will spread to everything I touch; that I will get hepatitis or AIDS and give it to others; that not doing things three times will cause Mum to be in an accident or Ella to be unhappy at school or Tuffy to get hit by a car. Her threats change so fast, it’s difficult to keep up.

  According to Dr. Finch, linking how many times you do something to bad things happening is an unhealthy behavior done by lots of people with OCD. It’s called magical thinking: where you believe you can control outcomes through your actions, even though you can’t. So I keep reminding myself that magical thinking is a waste of time.

  Mum can’t take us to Fieldness today, so we get a taxi from school. Knowing Mum’s not in the waiting room downstairs emboldens me to confess something.

  I tell Dr. Finch: “There’s something I haven’t told you.”

  “Go on.”

  “I think I’m a psychopath.”

  “Why?”

  “I have this thought.”

  “What’s the thought?”

  “I . . .” I try to tell her, but She won’t let the words go.

  She’ll section you. She’ll report you to the police. Don’t say anything. This is not a thought to be shared with others.

  “I can’t do it.”

  If you tell her, I’ll leave.

  “Try me.”

  I mean it.

  “No, honestly. This won’t be something you’ve dealt with. I’ve heard that people with OCD tend to be caring. You’ll be disgusted.”

  “Try me.”

  “I worry . . . I . . . My mum’s best friend has cancer. And I can’t stop thinking that I want her to die.”

  The words come out in a rush. I expect her to push a panic button under her chair and for security guards to storm the room. I haven’t even told her about the other thoughts:

  I’m going to stab people in the dorms next to me while they are asleep.

  I’m going to push Ella into the road.

  I want my family to be in a car crash.

  “Do you really want her to die?”

  “No! That’s the last thing I want. That’s why I’m so upset that I can’t stop thinking I want her to die.”

  “So then that’s it. It’s a random horrible thought that pops into your head, an intrusive thought. Everyone in the population sometimes has intrusive thoughts. Someone who has OCD is more likely to think they are hugely significant and ruminate about them.”

  She gets up and rummages through some papers on her desk, before finding a printout of a list headed “Common Intrusive Thoughts.” It’s quite a list:

  Thought that you might jump off a bridge or into the road

  Thought that you may “lose control” and start attacking someone

  Thought of a sexual nature about someone inappropriate such as a family member or a child

  Thought that goes against your sexual preference

  Thought of doing something inappropriate in a religious place

  Thought that you may have committed a crime you have read about

  Thought of an authority figure naked

  Thought that you are going to start swearing in public

  Thought that you want someone, particularly a loved one, to die

  “Healthy people get these thoughts. Most people have thought at a train station: ‘What if I pushed the person next to me on the track?’ But when someone without OCD gets that thought, they just think ‘Oh, that was weird, that’s not me at all,’ and get on with their life. A lot of the time they probably don’t even remember it. It’s a total nonevent. Someone like you has a different reaction.”

  How can it be that the dark thoughts She said made me uniquely evil are just a characteristic of an illness?

  I am torn between feeling frustrated that I didn’t know this before, and utterly relieved that I am not a dangerous person.

  I need clarification. Not being able to stop these thoughts doesn’t make people with OCD evil and dangerous?

  “On the contrary,” says Dr. Finch. “The reason people with OCD find these thoughts so upsetting is because they are so completely at odds with their values. The problem with people who have OCD is that they care too much. They are some of the safest people in the world. No one with OCD has ever acted on an intrusive thought, nor will they.”

  “But
what if someone with intrusive thoughts goes to a doctor who doesn’t know much about OCD and thinks they are a psychopath?”

  “That can and does happen if the professional doesn’t have any experience of OCD. But most can usually tell it’s obviously not that, just from the amount of anxiety the person in front of them is attaching to the thoughts. Some psychopaths have these thoughts too, but they mean them and are not made anxious by them. For them it’s not a fearful thought. It’s something they actually want to do. The difference is paramount.”

  “How can I stop it?”

  “When the thought comes,” says Dr. Finch, “don’t push it away. That will make it worse. Just think ‘Oh, look. It’s that thought again. It doesn’t mean anything. It’s not me.’ Don’t attach significance to it. If it loses its power to be scary, it won’t hurt you anymore.”

  We run overtime. We are late for the taxi, and the driver in the courtyard is cross.

  Our breath sticks in our throat like we have swallowed a fly. We hate it when people get angry. Dr. Finch has come out too, which she doesn’t usually do. She puts her hand on my back.

  “I’m sorry,” she tells the driver, “it’s my fault. I kept her longer than I should have.” Then she turns to us. “See you next week.”

  I should say something, anything. Stutter good-bye or something. A thank-you. But I don’t know how. She put her hand on my back!

  She has turned already.

  She’s walking back, typing in the code, going through the door, oh god please turn around, please turn around, PLEASE TURN AROUND, even though she won’t, she’ll keep on walking, it meant nothing, she’ll see you next week, between now and then she won’t know who you are and—