One year on: Overcoming a mental health crisis & OCD | by Yvonne Tse | Sep, 2021

I think there’s this generally accepted idea that that you’re either mentally healthy, or not. I feel that reality is more like a spectrum for both mental health and mental illness — I found that the matrix below really helped me conceptualise the relationship between the two.

According to the Mental Health Foundation, 1 in 4 New Zealanders have had poor mental wellbeing in the past year. In some instances, prolonged poor mental health can lead to mental illness. However, some people who have been diagnosed with mental illness can recover to the point where it has little to no impact on their daily lives. To me, this notion of illness and wellness being either opposite, or mutually exclusive states is not quite right. An individual may spend their life traversing between quadrants, and for a lucky few, they’ll stay in the most desirable quadrant — but I struggle to think how an individual dealing with life’s complexities wouldn’t be at least moving up and down the vertical, experiencing varying degrees of mental ‘healthiness’.

I can’t take credit for this matrix, but I can’t find the original creator either?

The professionals tell you that recovery from mental distress is not a straight line. I can confirm that it’s not even one line. It has been brutal — physically, emotionally and psychologically. I’ve gone from not sleeping, to sleeping poorly, to sleeping-with-weird-dreams, to night sweats. I’ve gone from frightening weight loss to my pants not fitting. I’ve cried as much as I’ve laughed. It’s a messy, complicated process that no one can ever prepare you for.

The worst journey map ever (literally)

It took four months to find the right medication, one that would finally work. For four long months, on top of my brain misbehaving, I battled chronic insomnia, and medication-induced diarrhea. The insomnia was to a point of absurdity where I couldn’t even nap — sleeping aids only brought partial relief. Shortly after my 30th birthday in November I hit rock bottom again — physically spent and mentally exhausted. It was an endless drug cocktail until we found ‘the one’ — and then I stabilised enough to tackle therapy.

No one ever told me of the cruel game of patience I was about to play, on top of dealing with my broken brain. Most psychiatric medication takes 4–6 weeks to show full effect (and sometimes it doesn’t work — like it didn’t for me). It took sheer willpower to get through this, and I depended a lot on my husband, family, friends, and workmates during this time.

Not so long ago, I would have told you that OCD was to do with cleanliness, germaphobia, orderliness and tidiness. The classic stereotypes. I have never been more wrong.

OCD is made up of obsessions (uncontrollable, recurring thoughts) and compulsions (repetitive actions and/or behaviours). I live with a form of OCD called ‘Pure-O.’ I have harm-related thoughts (and the fear of losing control), but very few physical compulsions that others can see. My compulsions are mental — excessive reflection, checking through my past to see whether there was evidence of me being “bad,” seeking answers and reassurance. When I was at my sickest, the compulsions manifested as physical avoidance — I couldn’t go outside, watch TV, go on social media, or read the paper for fear of triggering an unwanted thought. My world caved in overnight.

When people stereotype OCD, they think of cleaning and ordering. While Contamination OCD and Just-Right OCD are OCD subtypes, what most fail to understand is that for people who live with OCD, the compulsions to clean, to tidy, to put things in order — isn’t a choice. It’s often a time-consuming, debilitating ritual that is in direct response to an intrusive thought. Like, if I don’t [do this action/clean this thing/repeat this action] then my whole family will die. It’s not a useful condition to live with.

So when people joke about being “soooooooo OCD” — when actually talking about their personal preferences and choices to be orderly/tidy/pedantic, those words weigh heavily on those like myself who live with this incredibly frustrating condition every single day.

I don’t choose to be OCD. I live with OCD. I wouldn’t wish it on anyone else.

Apparently the whole population has weird, disturbing thoughts. It’s just that no one talks about them.

Thought about what it would feel like to step off a cliff? Doesn’t make you suicidal.

Watched the news and wondered whether you could possibly commit a crime? Doesn’t make you a bad person.

Thought about the possibility of hurting someone? Doesn’t make you a murderer.

Our brains are creative and curious, and can land us in some weird places. The difference between me and the majority of the population, is that I had one of these thoughts and I wasn’t able to rationally dismiss it. Instead, I kept asking myself “what-if” and “what do these thoughts mean” — creating an infinite loop of thoughts and intense anxiety. I got stuck.

Here are some helpful analogies that have helped my friends understand OCD:

  • If thoughts are like email, and intrusive thoughts are spam — with OCD, the spam filter stops working.
  • It’s like living with a real-life horror reel of your worst nightmares stuck on repeat.
  • It’s the worst game of thought whack-a-mole you’ll ever play, because just as you manage one theme, another seemingly pops out of nowhere.
  • For anyone into Harry Potter, it’s like having a Boggart (an amortal shape-shifter that takes on the form of it’s victim’s worst fear) following you around constantly.

Anyone with OCD will tell you — it’s exhausting. Nicknamed the “doubter’s disease”, the brain is sent down an impossible path to pursue certainty. For me, I was trying to figure out whether I could ever be a bad person.

It was third time lucky — I started working with a therapist in February who knows how to treat OCD with Exposure Response Prevention therapy (ERP), a proven effective treatment. It has been hard work, but life changing.

Unfortunately, I had to learn the hard way that the inappropriate therapy can cause more harm. The first therapist, who I saw in the lead up to my breakdown, encouraged me to replace “bad thoughts” with good ones, and to tell myself repeatedly that I was a good person. Unknowingly, this advice turned into a compulsion, which made me much worse.

My second therapist was a clinical psychologist insisted that simply talking about my OCD in sessions was exposure, and pushed me towards EMDR (eye movement desensitisation and reprocessing), her preferred method of treatment. I personally did not find it effective, and lasted eight sessions before I pulled the plug. It is important to note that some people do find EMDR useful for OCD.

Turns out that being struck by repetitive thoughts in the middle of English class of the house being on fire because I might have forgotten to turn off the lights isn’t a typical worry that other kids have. I also recall periods of my childhood where I’d create these complicated internal narratives about where certain objects might have been, and I’d struggle to articulate why I couldn’t use or touch those items.

It was a revelation to learn that I’ve had intrusive thoughts for years, waxing and waning in intensity during times of stress.

My irrational fear of knives began as a child, after a family friend committed suicide and I started having suicidal-OCD intrusive thoughts, frightening myself with different ways I could hurt myself, even though it was the last thing I wanted to do. I grew out of it, but the fear came back with vengeance when my parents separated. I was stuck with paralysing “what if I hurt myself or someone else” thoughts that looped, and avoided sharp objects at all costs for a couple of months.

During university exam season, I went through a terrifying stint of what I now know as responsibility OCD, specifically, ‘hit-and-run’ OCD — where every crunch under my tyres would send me into a tailspin that I’d hurt someone. I’d end up repetitively checking the rear-view mirror, and driving around the block to check again. When I got home, I’d check the car for scratches, and then check the news to make sure there wasn’t a hit-and-run story. I was racked with guilt, for something I knew probably didn’t happen, but I just wanted to be sure.

All these obsessions disappeared with time, and any person I broached with these weird thoughts just told me that I was being a “worry-wart.”

Through this recovery process, I have had to learn to slow down and to celebrate the little wins. And little, they were.

At first, it was caring enough to get dressed. Going outside. Surviving my first week back at work was huge. And then came the bigger wins — going out for a run — and not having OCD completely destroy it. Every little win, my husband and I celebrated as a victory, an informal ‘take-back’ of my identity.

A very nerdy reference to Maslow and his hierarchy of needs

It’s been well-publicised that the New Zealand mental health system is broken. I was told I’d be waiting months to see a therapist, and was advised to go private immediately. Going private was life-saving — but even then, I found it hard to actually find a therapist who knew how to do ERP. I was waitlisted and outright declined by some clinical psychologists whose workloads were too high.

I’m also educated, digitally literate, have a strong support network, and financially stable. This meant I was able to figure out what was going on with my brain, research treatment options, and pay for treatment immediately. If one of these factors had been removed, I highly doubt that I’d be at this stage of recovery. My recovery story is one of privilege, and it’s not something I take for granted.

I often think about other people I met in respite and in waiting rooms. For some, basic clothing, housing, and technology needs were not met. These stressors likely exacerbated their poor mental state. The ‘meds and beds’ model simply isn’t enough — the reality is, for many, the healing comes with therapy and the cognitive strategies that help you cope in daily life. Unfortunately, it is out of reach for most.

Good luck navigating this flowchart

I grieve the loss of who I once was, the pre-OCD version of myself. Life before diagnosis was a lot simpler. When making life choices now, I consider the impact on my mental health before anything else.

Given OCD’s brutal nature of ‘latching onto things that you care about and twisting it’ — I’ve been told to expect it to rear its ugly head. My OCD flare ups are now a barometer to indicate my overall stress levels.

Managing my mental health is a full-time job.

There are also other unexpected consequences I’ve dealt with — such as mental health discrimination while trying to apply for life insurance — but through this, I’ve found an unexpected advocacy streak inside of me — speaking out against injustices as I see them.

Going through a crisis has made me realise that people who live with mental health challenges, or have overcome them, have an indeterminable level of strength that many will ever understand. It’s unfair that society continues to stigmatise mental illness and associate it with weakness — when in reality, it’s a biological illness that one cannot control. Telling someone to ‘get over’ depression is about as logical as telling someone to ‘get over’ heart disease.

For me, I found inner strength that I didn’t know existed. As a reminder, I now wear a small semi-colon tattoo on my wrist — my story isn’t over.

The past year has been brutal. I really resented the fact my brain broke. I was desperate to move on as quickly as possible — without realising the massive effort it would take to recover. As a psychiatrist put it bluntly, I needed to think of my mental health crisis like my brain being in a car crash. This analogy changed my perspective on recovery.

If you broke your leg, no one would expect you to be back running next week. The expectation on your brain to recover from this should be no different,” she said.

Over this year, I’ve also had time to reflect on how my OCD-prone brain has served me, particularly in my academic and career pursuits. I’ve always had a vivid imagination, losing myself in the world of literature as a child. As a student, I was always able to think about endless possibilities when analysing a problem. The catastrophising, perfectionism and crushing anxiety around exams was less helpful, but I’ve never had an issue coming up with creative, unconventional solutions.

My easily-bored and persistent brain has meant I’ve switched career paths four times in six years — from financial auditor, to software tester, to UX researcher, to management consultant — always itching for a new challenge. Now that I work with clients on complex problems, being able to think differently and visualise concepts has been useful.

OCD has made me realise that I care deeply. People with OCD are often gripped by fear of harming themselves or others, engaging in debilitating rituals to try and keep others safe. It’s somewhat bittersweet — a protective mechanism on overdrive.

For all the ways my brain doesn’t cooperate, when it does, it can be magic.

I never envisioned having my face splashed across some of New Zealand’s biggest publications and my entire mental health history available for the world to read. Talking about this publicly is the hardest thing I’ve ever done in my life.

But when I was lying in that respite bed a year ago, it was a frantic Google search and uncovering the Pure-O stories of Rose Cartwright, Aaron Harvey and the Made of Millions website that gave me enough hope to keep living. And thank goodness they trail-blazed, because I wouldn’t be here if they didn’t open up to the world about their most feared thoughts.

Stories are powerful, and in my case, life-saving.

I told my story because of how misunderstood OCD is in New Zealand, especially ‘Pure-O’. ’Through that article, I’ve connected with countless strangers who have finally found a story they can relate to, or an answer to their struggles. That alone has been worth it.

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