by Jeff Bell
“Didn’t I run across a story in the wires just last week about some body found near a curb in your county?” I ask.
The assistant has to think for a minute. “Yeah, that rings a bell,” he says very matter-of-factly.
“You guys ever figure out the deal with him?”
“Nah, still no positive ID.”
“How ’bout the cause of death?”
“Pretty clear OD, as I recall.”
Bingo!
We talk for a few more minutes before I thank the unsuspecting assistant for his time and lie that I might be calling back for more information for my series.
“No problem,” he says. “Glad to help any time.”
As I hang up the phone, the reality of what I’ve just done hits me with the force of a speeding locomotive.
ten
fast-forward 3 days
Fluoxetine. Sertraline. Fluvoxamine. Paroxetine. Citalopram. The names all sound so wicked to me, like labels for some hideous poison an exterminator might use on the most hardened of rodents. They are, in fact, the clinical names of six antiobsessional medications known as selective serotonin reuptake inhibitors, or SSRIs, and with great resistance, I am learning everything there is to know about each.
My research comes on the heels of a total meltdown in Jackie’s office and in advance of my scheduled meeting with the psychopharmacologist in Berkeley to whom Jackie has referred me. I still can’t believe that I’m going on medication, and I hate myself for ever agreeing to do so, but not nearly so much as I hate myself for my call to the coroner, a moral transgression so nefarious that I can share it with no one, including Jackie. I just danced around the whole thing the next day as I sat in her office and watched my emotions unravel, one fragile strand after another. Then Jackie spelled it out for me. “I can’t help you, Jeff, if you’re unwilling—or unable—to do the hard work that’s needed.” And that’s when we got back on the topic of meds and how they might fit into my recovery program. After three or four adamant no’s, a muffled yes somehow slipped out of my mouth.
So now here I am doing more investigative reporting, ferreting out every tidbit on SSRIs that I can from my stack of OCD books. Like most of the hard facts about this mysterious disease, these are about as hard as soggy corn flakes. The experts agree, for example, that SSRIs work to block the reabsorption of a neurotransmitter called serotonin at the synapses between nerve cells, thereby increasing its availability in key areas. But precisely why this is beneficial, no one’s entirely sure.
Not exactly the most reassuring of explanations.
Jackie has promised that I’ll need to stay on meds only as long as it takes me to master her behavior-therapy skills. While that time frame remains to be seen, at least one of my books suggests that nearly half of all OCs on medication need to maintain at least a low dosage of their drugs for a good many years to avoid major relapses. This, more than anything, has me questioning everything. I just can’t handle the notion that I might forever be dependent on some little pill to keep me alive.
Apparently, I’m not the first OC to struggle with this concept; it seems enough before me have to warrant a whole section on the topic in one of my books. I should compare my illness with diabetes, I’m advised in Getting Control. A diabetic needs insulin to live a normal life, the argument goes, so what’s so bad about an OC needing anti-compulsive medication to function normally? But medical problems are different, I shout at the book, only to read on to the reminder that OCD is a chemical disorder.
Yeah. Maybe. But it’s still different, I know, and no book could ever convince me otherwise.
I’m guessing you’ve already picked up on this fact, but still, it’s probably worth noting here that an obsessive-compulsive’s world is black and white. One hundred percent so. Shades of gray just don’t exit, perhaps because our brains are incapable of processing them. Things are either good or bad, right or wrong, acceptable or unacceptable. All things. Always.
I’ve lost track of how many “normal people” have told me they just can’t understand my early aversion to meds. (You recognized you were sick, you wanted to get better, you knew the pills could help.) But that’s because they’re normal. I’m certain other OCs would understand the logic I applied in those days: People are either crazy or sane. People who take psychopharmacological drugs are crazy. Take the pills, and I concede I’m crazy. Quod erat demonstrandum, or Q.E.D., as my geometry teacher used to say.
No doubt it was this same black-and-white framework that made telling my closest relatives about my new label one of the most difficult things I’d ever done. How does one go about telling family that the son or brother or in-law they seem to know so well is not at all the person they think he is? That he’s been diagnosed with a chronic brain disorder and is, in fact, by definition, mentally ill? Damned if I knew how. Phone calls? A press conference? Singing telegrams?
In retrospect, any of the above probably would have made more sense than the approach I ultimately opted for: a long, rambling letter that began, “It’s time for me to do some explaining” and ended, “Pretty heavy stuff, all this information I just laid on you … I really don’t know how comfortable I’m going to be talking about this for a while.” On the many pages in between, I wrote out what I could about my recent research and Jackie and the meds I was about to go on. I also inserted a photocopy of the driving anecdote from The Boy Who Couldn’t Stop Washing, explaining how a similar episode—and not a work delay—was the real reason I’d been hours late arriving to a recent family party. And I did my best to connect a long series of other dots for them.
Talk about a bombshell! No one knew what to say, or even whether to say anything, given my own request not to broach the subject just yet.
In the weeks and months that followed, there were comments here and there, but mostly awkward smiles, the kind we all resort to when words aren’t really an option. Mandi sent me what struck me then, as it strikes me now, as the perfect care package—a big bag of Hershey’s Hugs—and Mom, bless her heart, called several times to tell me (1) how much she loved me, and (2) that my father was reading everything he could on the subject. “You know, it’s his way of dealing with things like this,” she explained.
As for me, I spent countless nights imagining the damage my incriminating note could do to my permanent record and contemplating whether I should ask for all the copies back. If someone had told me that a decade later I’d share the stuff of that note with anyone caring to read it, I’d have deemed that person even crazier than I considered myself.
Samantha comes with me to Berkeley for my first meeting with the pharmacologist (whom I’ll call Dr. Smith). We wander Shattuck Avenue on our way to his office, and the irony hits me. Here we are in one of the craziest cities in America, passing old beatniks and hippies left over from past decades on one street corner, long-haired preachers barking doomsday prophecies on another. Yet even they, and the rest of their fellow societal misfits, are capable of carrying out the many basic functions that are quickly slipping out of my reach, like driving a car and spending time around kids. And how about all these addicts taking refuge in the narrow doorways around us? They too, I decide, have a leg up on me. At least they’re not on drugs because some doctor told them they really should be.
At ten o’clock, we knock on a door marked Dr. Smith. Two minutes later, Sam and I stuff ourselves into the cramped quarters that serve as his office. Lots of books on his shelves; lots of degrees on his walls; and behind his desk, a man in a button-down Oxford with wire-rimmed glasses and a neatly trimmed beard. Definitely not your typical Berkeley resident.
“Jackie says the meds will only be temporary,” I volunteer seconds after our brief introductions.
Dr. Smith stares back at me, expressionless, and I try my best to read his reaction.
Nothing.
“You see, it all started two years ago with this boat mishap that—Well, no, actually, it really started when I was just a kid, with all these thoughts that
would get stuck in my head—”
Still nothing from the doctor. I’m missing something here. I let my confusion show on my face.
“Dr. Persons has briefed me on your history,” he finally says.
My history? What the hell is that: a loony’s permanent-record equivalent of a criminal’s rap sheet? Does it sit in some shrouded filing cabinet that all members of the Clandestine Psychiatric Society of America have access to once they master the secret handshake? I’m getting a good case of the creeps.
“Dr. Persons and I do a lot of work together,” he continues. “We’ve had a great deal of success combining cognitive behavioral therapy with short-term drug treatment.”
Now I get it, and I feel like an idiot. I’m not here to reinvent the wheel, to tell my whole drawn-out story to yet another shrink. Dr. Smith is Jackie’s drug expert. He’s going to implement and supervise whatever medication plan the two of them have devised. Psychologists don’t dispense pills. Psychopharmacologists do. It’s a tag-team sort of thing.
I shut up and let Dr. Smith launch into an overview of the various options for my drug treatment program. After my hours of research, I’m with him every step of the way.
“I think we should start with fluoxetine and see how you respond,” he decides.
“That’s Prozac,” I say. “Isn’t it used to treat depression?”
“Yes, but in lower doses than we typically need to tackle OCD.”
Great. Now we’ve established where I stand on the Universal Nutcase Scale.
“I’m afraid of drugs,” I say.
“A lot of people are. We’ll help you through that.”
“But I don’t trust my senses as is. How can I be sure the meds won’t make me even less responsible?”
“You’re going to have to trust us.”
“There are side effects though, right?”
“Yes, there are,” Dr. Smith says, handing me a slip of paper, the AMA’s Fluoxetine/Sertraline Patient Medication Instruction Sheet. “You should also know that many OCs need a good four to six weeks before they experience any real antiobsessive benefits from the medication.”
We talk for a few more minutes and arrange to meet again in about three weeks. Dr. Smith encourages me to call if I have any questions.
The drug effects kick in for me in a matter of days, not weeks, and the first thing I notice is how jittery I feel. It’s almost like that overly keen sense of perception six cups of coffee gave me after an all-nighter in college. Even the slightest sounds and movements grab my attention and make me jump—yet somehow only within the confines of my skin. I keep looking down expecting to see my whole body shaking, only to find that I’m standing still as can be.
As much as I’d like to deny it, I know the pills are also having a positive impact on my neurotransmission system, at least when it comes to my what-if? thoughts. The disturbing recurring questions still pop into my head, and frequently, but it’s almost as if they now have to compete for attention with a whole slew of normal thoughts about everyday things—Hey, I wonder what’s for dinner; that’s a great outfit on Sam; Brianna sure is growing up quickly—those sorts of mundane observations I never even realized were missing.
The most pronounced effects of my medication, though, are not medical ones. They are the emotional by-products of my struggle to come to terms with this whole drug-taking concept. I’ve read Dr. Smith’s list of possible side effects again and again, and while I’ve experienced none of them, a few of the “precautions” still scare the hell out of me. One in particular is especially disturbing: “If you are taking fluoxetine, dizziness, lightheadedness, or fainting may occur …”
Dizziness? Lightheadedness? Fainting? And I’m supposed to trust myself to get behind the wheel of a car or walk through crowded places? I don’t think so! The possibilities are endless for the new damage I could inflict. How ironic that these wonder pills that are supposed to be making me all better are, at the same time, giving my monster, Doubt, so much new ammunition.
eleven
fast-forward 3 months
We are making progress, Jackie and I. Week after week, she tightens the limits on my compulsive rituals, and week after week, I learn I can survive with that much less checking and rechecking of everything around me. We pore over charts of my time spent ritualizing and plots of the intensity levels of my various obsessions. There’s no question things are moving in the right direction. “But it’s time to notch up your discomfort level,” Jackie tells me one morning in late December, four months after our first session together. “I want you to start tackling some serious exposure/response-prevention exercises.”
I stare at her and shake my head. “You’re kidding, right?”
“No. And don’t look surprised. We talked about this. You need to start exposing yourself to more of your fears.”
“Why? They seem to find me just fine on their own.”
“But that’s the point,” Jackie says. “You’ll only be ready to deal with them when they hit if you’ve conditioned yourself first.”
“And I do that by … ?” I know the answer.
“Learning to sit with the fear. If driving down narrow streets still gives you the creeps, then we need to send you down five of them a day and keep you from looping back for a look at the damage. Do this enough and you’ll desensitize to the fear. Trust me.”
Trust is not the issue here. I am exhausted—physically, mentally, emotionally—in ways I didn’t even know were possible. I’m in no mood to pick fights with Doubt. I tell Jackie that her timing stinks, that I’m just starting to feel as if life is getting back to normal.
“Normal, huh? You really think so?”
“Yeah,” I say, but I see the trap I’m walking into. I know she thinks I’m in denial about the extent of my challenges.
“Okay, then let’s take a little inventory, shall we.”
Jackie is all smiles now as she scribbles a note on my weekly homework sheet. She always takes such pleasure in calling my bluffs.
“Here’s the deal,” she says. “I want you to keep a log of every OCD episode you battle over the next seven days.”
“That’s it?” I smart off, knowing it’s not.
“Almost. I also want you to go over your list when you’re done, then try to make sense of it relative to everything we’ve been talking about.”
Over the course of our work together, Jackie sent me home with dozens of assignments—far too many of which I blew off entirely without ever confessing as much to her. This particular logging exercise, however, was one I gave my full attention to. And today, with the benefit of hindsight, I can see how significant it proved to be, largely because of what it made me face: the reality of just how much of my life Doubt had stolen from me.
I’ll spare you the tedious details of my journal entries for that week (you’re welcome), but I can’t help thinking that a quick overview here might prove as helpful to you as Jackie’s exercise was for me—at least in understanding the complexity of my day-to-day life in the mid-1990s. Really, it all boiled down to six sets of time-gobbling compulsions, each one leading back to a single all-too-familiar obsession.
The Obsession. I can’t speak for all obsessive-compulsives, but among my own circle of OC friends, we each have a root obsession—the heart of every other obsession we might ever have, and the driving force behind all our rituals. I sometimes think of it as the calculated work of our internal bully, the single most effective weapon our nemesis, Doubt, can conjure up to taunt us with. For me that root obsession has always been this: What if, through my negligence, I unknowingly harmed, or might harm, someone or something? The boat incident, the road cone episode, the Hawaii hubcap, the disappearing homeless guy—all fit this boilerplate to a tee, wouldn’t you agree?
Most obsessions are triggered by particular events, and my notes from Jackie’s logging exercise are filled with those: lane changes, spilled liquids, mysterious sounds, and so on. But as I also noted that week, some taunting t
houghts are really more like “envelope obsessions.”
I can’t remember now if that’s a Jackie term or one I’ve coined along the way. In either case, I’ve come to use it to describe those rotating intrusive thoughts that seem to lurk at the outer envelope of my consciousness. They’re always right there, quietly waiting for a lull in the chaos of daily triggers, ready to strike at a moment’s notice. The end of the day, first thing in the morning, the middle of the night: all are prime times for their attacks, as are vacations and traditionally “happy” occasions of any kind. When they hit, they hit hard—no matter how many times they’ve hit before—and they always lodge themselves front and center until a new, more pressing thought is ready to take over. This could be minutes, hours, or even days.
By the time of this logging exercise, most of the episodes you’ve read about had slipped into such an envelope mode, each demanding far less of my attention than it initially did, but each still packing every bit of its original punch.
Mental Checking. I know that by now you’ve got the gist of this one. The virtual tape reviews. The constant mental re-creations of one event after another, always in some futile attempt to un-stick some stuck thought about harm. Play. Rewind. Play. Rewind. You get it. But there’s one other layer to this compulsion you should also know about. I call it “life reviewing,” and it stems from Doubt’s most unsolvable question: What if you’re just a horrible person? Only one way to be sure, it tells me, and that’s to look back on my life and rule out the possibility that I am, in fact, truly despicable.
Conveniently enough, this introduces a lifetime’s worth of tapes, and back in the mid-1990s, I spent countless hours going through them, attempting to ferret out the evidence tapes—like the Potato Bug sequence that haunted me many a night. I am five years old in this tape, playing by myself in my parents’ backyard planter box. I am pulling a potato bug apart into two even sections, as I learned to do from a group of kids on the kindergarten playground just hours before. With the fascination of a scientist, I am observing the phenomenon that the other kids had noted: that the two separated halves continue to move about independently.
