Real Life with OCD: A Conversation with David Adam

David Adam: I think I'm quite unusual when it comes to OCD because I can remember to the day, to the moment that my OCD began.

Dr. Andrea Bonior: Today we're talking to journalist and author David Adam, who goes deep into his longtime struggle with OCD and how he was able to get help and ultimately help others. It's personal, it's real, and it helps us. The myths that so many of us have when it comes comes to what we think OCD is like. If you've ever been confused about what obsessive compulsive disorder actually is, or if you know the struggle all too well, you'll want to listen to today's Baggage Check. Welcome, everyone. Can I say everyone?

Dr. Andrea Bonior: Do I have to have a certain amount of listeners to say that? Because I will say we've been reaching some recent milestones and we are growing quite a bit. Anyway, I'm Dr Andrea Bonior and this is Baggage Check: Mental Health Talk and Advice, with new episodes every Tuesday and Friday. Baggage Check is not a show about luggage or travel. Incidentally, it is also not a show about the fourth valve of the flugelhorn. All right, let's get going. Today we're going to be talking about obsessive compulsive disorder, or OCD, one of the most widely mentioned but also widely misunderstood psychological disorders. So it's really exciting to me that I'm able to bring you somebody who has struggled with this himself and who's written about it and speaks about it. His name is David Adam and he's a bestselling author and journalist. His book “The Man Who Couldn't Stop: OCD and the True Story of a Life Lost in Thought” details his struggle with OCD. And he was kind enough to speak with us today. For those of you who don't have a real familiarity with OCD, I'll give you just a moment of the basics. OCD is made up of two components. Most people have both components, but technically you could just have one or the other in order to meet criteria for it. The first component is the O, the obsessions part. Those are intrusive, repetitive, disruptive thoughts that become really bothersome. There are some obsessions that are very common in folks with OCD. But really, obsessions could be just about anything. Anything that's repetitive and intrusive, where the thought itself becomes so bothersome that it causes distress. David's obsessions involve the possibility of being infected with the HIV virus. For some people, it's a fear of germs or other contamination, or it's a sexual thought or an aggressive impulse or the need for things to be symmetrical. The second component of OCD is the C part-- compulsion. Those are the behaviors that someone repeats. Some people call them rituals, but these develop into habits that are attempts to try to deal with the discomfort of the obsessions. Compulsions can be mental. You might be doing a behavior in your head like counting. Certain common compulsions are counting out loud or in your head, as I mentioned, or checking or washing or repetitive body movements. For David, the ritual involved seeking reassurance from others that he had not been infected. Of course, the more the obsessions bother you, the more you engage in the compulsion and you start to get trapped in that cycle because the compulsion doesn't make you feel better for very long. And you get so bothered by those obsessions, those intrusive thoughts, that your whole life starts to shift around the distress that's being caused by them. It's really a vicious cycle, but there is help, which we'll talk about in this episode. There's so much to say about OCD, and no doubt we will have many episodes covering different aspects of it in the future. For now, I'm just thrilled to bring you David's story in his own words. And one final note, this show does mention blood and also physical intimacy between a married couple. Nothing graphic or gory, but just be aware in case there are sensitivities or little ears listening. Of course, some of you might have just gotten a lot more interested. In any case, here's the show. So, David, I am really glad that you made the time to join me today. And I really think that OCD is such an important topic and there's so much misinformation about it. So I really appreciate you being here.

David Adam: Oh, you're welcome. Thanks for the invitation.

Dr. Andrea Bonior: Yeah. So why don't we start with hearing more for you, how your OCD story got started and what you've noticed early on when some of your symptoms became an issue for you.

t was a long time ago, it was: 1991

Dr. Andrea Bonior: Right. Um, yeah.

David Adam: So that was my OCD.

Dr. Andrea Bonior: Yeah. And so it really sounds like it totally snowballed pretty much right away. You have that first intrusive thought. You can even remember the moment of that. And because that thought was so distressing, was so out of nowhere, in an upsetting way, you really moved towards some compulsive reactions to it pretty quickly. Is that right?

David Adam: Exactly. Yeah. Well, of course, at this time, I didn't realize it was a compulsive reaction. I didn't realize these were intrusive thoughts. I just thought that, um, I could rationalize it if I could show myself. So I couldn't understand why I wasn't accepting my own reassurance. So I thought, I'll just get somebody else's reassurance. I'll hear it from somebody else. That will do it. That will work.

Dr. Andrea Bonior: Right. And of course, as you mentioned, it works not in the least, and actually keeps the cycle going. At what point did you feel like, okay, maybe there's a name for this. Maybe this is something that is fairly specific, having to do with the way that my brain is working?

David Adam: That's a good question. I think at the time, I thought it was some kind of phobia. That's how I identified it. I knew people who were very scared of spiders, and I thought that that's what this was. And I very naively just assumed it would go away in time. I kept saying to myself, the next day, I'll just do this check or this seeking reassurance one more time and then everything I'll wake up tomorrow and everything will be fine. And of course, it didn't, and it doesn't work like that. So I hadn't heard the term OCD. At the time. I think I went to see a psychiatrist a few years later and that was the diagnosis, was OCD. Which is the first time I think I put two and two together because I still think I think I thought that this was i, uh, said I didn't really understand what OCD. Was. And to me, I was behaving in a rational. My response was rational, even though the thoughts weren't, because I thought, I'm doing what I can to show myself, to try and answer these thoughts, to try and respond to them. I would say it took a few years, I think, um, for me to get a diagnosis. And I don't think in the period in between I thought I had OCD. I thought it was some kind of phobia. And even when they diagnosed me with OCD, I still resisted it and thought, well, this isn't I'm not behaving irrationally. I'm thinking irrationally, but what I'm doing is what anyone would do in this situation, right? So I, uh, thought it was the thoughts that were the problem. And again, we can get on to this. When I eventually had treatment, one of the things that I wanted was the thoughts to be taken away. But of course, we know that's not how it works.

Dr. Andrea Bonior: Exactly. And I think that's important for our listeners, that for a lot of people that have things like phobias, it can be a matter of recognizing, hey, that dog's not going to kill me. Some exposure therapy, in the sense of realizing that you're safe with the dog, can provide some reassurance over time. But with OCD, that reassurance kind of feeds the idea that the thoughts basically keep coming back because the reassurance, as you mentioned, doesn't work. And so in your mind, you're thinking, well, as long as I reassure myself, then these irrational thoughts will go away. But in reality, the way that the irrational thoughts are perpetuating, that in and of itself is such a cycle that makes OCD. Stand out, those thoughts themselves become so distressing, so pervasive, so sticky, that they create this really big cycle of helplessness. And I'm sitting here imagining you going through this for several years, even before you get that oct diagnosis. Did it really kind of hover around the obsession of HIV or did you start to see additional obsessions and additional compulsive behavior spread?

David Adam: No, it was only around HIV and AIDS. It was very particular. I mean, I'll give you an example of just how extreme it was. I would play football, for example, or soccer. And, um, we'd play an Astroturf, which in those days was like sandpaper. And I would fall over and I'd scrape my knee and I'd get home. Because while I was playing football, I was playing soccer, I was fine, I wasn't dwelling on things. But then, um, when I got home, I started thinking about what could have happened. And I thought, well there could have been blood on that pitch. Someone else could have fallen over at that exact space. They could have left a smear of blood behind. That could have been HIV infected blood that could have got into my system. Therefore I could have caught HIV. Now, twelve months ago, I would have left at that idea. I would have thought, it's just so ridiculous, it's so far fetched, it's not even worth considering. But the thing about OCD, or my OCD end, was that I couldn't, I had a blind spot when it came to HIV, not with anything else. I was happy to take other very small risks. I drove, I would fly in an airplane, even though there was a genuine but very small risk of a disaster. But uh, with HIV I just couldn't live with that small amount of uncertainty. So at the time there was a telephone number you could call, a national AIDS helpline, and I would call it and I would say things like, this has just happened, I was playing football, I hurt my knee, there could have been blood on the ground. And they would say, no, nothing to worry about. The risk of that is very low. Um, so I got a little hit of reassurance that everything was going to be okay because this reassurance was external, it was somebody else saying that. And I put the phone down and it shows how long ago it was, by the way, because this was in a telephone box. This is back in the day when phones were still nailed to the walls and if you wanted privacy, you had to leave your house and find a phone box. And I would go to leave the phone box and then a little voice in my head would say, wait, the risk was very low, so it's not zero. So actually there could be a problem there. I need to describe it in a different way. I need to describe it better. They might tell me there was a risk and this would go on and on and on. It got to the point where they would start to recognize my voice when I called them back and say, we've just spoken to you. You need to go in and accept this. And of course that's what OC just does not permit. It does not permit you to live with that, uh, very small chance, with that uncertainty. OCD demands certainty, which in some things is impossible.

Dr. Andrea Bonior: And that's at such the heart of a lot of anxiety disorders, really, is this real difficulty, struggling with uncertainty. And we actually measure that in a lot of the research, this uncertainty intolerance, so to speak. And I think what's hard is that in life. Uncertainty is a given. The only certain thing, really, is that there will be uncertainty. And so on a daily basis, you're trying to get reassurance, and there is no reassurance to the 100% stance that you can actually achieve. And these experts are saying, oh, your risk is very low. And what you're hearing is, hey, that's not zero.

David Adam: Yeah, there's a scene in a movie, I can't remember what it's Jim Carrey and Cameron Diaz. And, um, he says something like, what are the chances if you go on a date with me? And she kind of thinks and says something like 10 million to one. And his response is, you're telling me there's a chance it's that you focus on the one in a million? Because why shouldn't that one in a million be me? I even worked it out. Someone once told me that the risk of catching HIV from kissing someone was one in a million. And I actually sat down and I worked out how many people there are in the world. Let's assume they all kiss two people a year, blah, blah, blah. And I worked out that two people a year would catch HIV through kissing. So why wouldn't one of them be me? That's the looting. And of course, it's not meant to be a predictive statistic. It's just meant to show you how very unlikely it is in your situation. And I wasn't really talking to anybody about this either. So the fact that it's all inside your own head just makes it very difficult. I just felt like I wanted to switch my brain off and start it again because I knew there was something going wrong, but I thought it wasn't that serious because the rest of my brain was okay. It was just this one particular thing. If I can just sort of have a break from it, almost forget it, and then I won't remember it again, and I'll just be able to go forward. So I had all these very naive ideas about how I would just I just wake up one morning and it would all be gone. And I think you will know better than I, but I think that's quite common with OCD. I think one of the reasons people don't get treatment for so long is that it's just so bizarre and so weird that you just expect it to stop, because it doesn't make any sense. It's completely alien, and, um, there's no reason for it. There's no benefit to it. And so you think it will go away, and it doesn't, unfortunately.

Dr. Andrea Bonior: And I imagine that's behind a lot of shame, too, because you know that it has a weird quality to it. You imagine that maybe you're the only one feeling this way. Did you feel that way?

David Adam: I definitely did, yeah. And it's because OCD tends to focus in on the things that we are. It is around kind of germs and sex and, um, violence and these things that we kind of tend to shy away from talking about anyway. So the psychiatrist who I saw at university, there wasn't a great deal of help in terms of what the treatments were, but he did say something which made a massive impact on me. And I said exactly that. I feel like I must be the only person in the world to have these crazy thoughts about HIV. And he said that he was treating three people at the university for the same thing and hearing that somebody else could be going through what I was going through.

Dr. Andrea Bonior: Yeah, that can really be a game changer.

David Adam: Yeah, it just rebuilt that connection. And again, this was before the Internet. It was before you couldn't just go online and Google your symptoms and there weren't chat rooms and there weren't support groups and all this sort of thing. So it gave me hope. I thought, well, okay, I'm not stranded on this crazy island all by myself. There are other people. And the fact there are other people going through the same thing suggests that it's not just my brain that's doing this. So therefore, there might be a way back. I suppose.

Dr. Andrea Bonior: Yeah. Do you think your loved ones or your friends would have noticed, or did they notice at the time? I mean, these years that you're going through this silent battle and you haven't yet gotten a diagnosis, and you're thinking, this is weird, but I can just reassure myself. Were other people aware of it, do you think?

David Adam: No, I don't think so. I think because my OCD was very portable, so I didn't have to turn lights on and off or wash my hands all the time or perform avert, uh, rituals, I could just be very frightened, and then I would go and seek reassurance in my own time. Now, I think it definitely affected the kind of person who I was. It affected me, my personality and my behavior and my decision making. But there's no reason why anybody else would know the reasons for that. They just saw the output.

Dr. Andrea Bonior: Right. Because your compulsive behavior in terms of that reassurance really wasn't as overt as a lot of folks compulsions, like you said. Where exactly? And I think there's a stereotype well, there are so many stereotypes of OCD that are often total misconceptions, and we'll get into those. But I think oftentimes there is a stereotype that with OCD, things are so over. This is the person that's very actively counting the number of steps as they go up them, or they're very actively arranging or sorting things in a certain order, or they've got some body movements that they must repeat in very specific ways. And then there are other folks where the compulsions themselves are more mental. They're doing things inside their head to try to reassure, like you, or to try to soothe the anxiety of the obsessions. And I think it just speaks to the fact that there are so many people for whom there are these silent battles being waged and if we're sitting next to them on the subway or even if we're eating dinner with them, we might not have any idea.

David Adam: Absolutely, yeah. Um, and that was certainly how it was with me. I told very few people, even by the time I wrote the book, because in fact, when I first signed the deal to write the book and the publishers wanted to put out a press release and I said, no, you can't, you can't tell anyone because I have to tell people like my parents first. I think it's partly because you're embarrassed by what it is that you're confessing to. And I think also there is just that awkwardness, uh, because of the topic. And I think also there is just this, because I sort of kept it to myself for so long. To me, it was the most important thing about me. It was the defining feature of me. And I thought, no one else is going to understand just how pervasive it is. Even I, someone who suffered it for so long, can't really appreciate just how consuming it was. It just doesn't seem possible. You can think the same thing all day, every day, for years. It just does not seem feasible. But it was and it still is for lots and lots of people, for sure.

Dr. Andrea Bonior: You really sort of came out with your story in a big way: “By the way, I have a book proposal about this and I've got to tell you now.” How was the response of, um, your friends and family when you did decide to convey to them what you were experiencing?

David Adam: Do you know what the best thing about the response was? That it was really understated because mhm, they'd be, uh, like, oh yeah, I know someone who's like that. Or I do a bit of that. Or I feel so there was no one to me, as I said, it was the most important thing about me, defined my life and the decision that I'd made. And I guess I would blame it for things that didn't go so well.

Dr. Andrea Bonior: Yeah.

David Adam: And I was expecting, I think, when I told people, for them to drop things and go, oh my God, that's terrible. Uh, right. Yeah. They just saw it as a part of me. To them, it didn't define who I was. It was just part of who I was. And it was very normalizing in a way. And it helped a great deal because very quickly, really good friends, we would I don't know what your phrases take the mickey out of each other. Um, we're quite taking the out of each other, but that's different in America.

Dr. Andrea Bonior: Busting each other's chops, maybe.

David Adam: Okay, right.

Dr. Andrea Bonior: We'll have to look it up later.

David Adam: Um, we'd just be teasing each other, I suppose. Uh, so good friends tease each other about things and it became something that they would tease me about very quickly, which meant I knew it was accepted. I suppose I felt it wasn't as big a deal for them as I thought it would be. I mean, by this time I was also I've had the treatment and I was in decent place again. It just helped, I think, to rebuild those connections because almost everybody in fact, there was some at the beginning of the book when I told people I was writing the book, that everyone wanted to share their own intrusive thought, their own really weird thought. And there was someone who they are relatively high profile in the UK now, in the media, and they told me that every time they went to the toilet, they were worried about rats coming up and biting them. And that went in the book because I thought, well, that's a good thing. But these people didn't have OCD yet. They had these intrusive thoughts so everyone could connect to it. Even if and everyone my age recognized the fear about HIV and AIDS. It wasn't like some topics for OCD are completely off the wall. This was a real disease that people did actually catch and affected their lives. So I think all of that helped. It helped me a great deal.

Dr. Andrea Bonior: Mhm.

Dr. Andrea Bonior: I think so many times with mental health disorders in general, there's a sense that the person is completely defined by it. As you mentioned, this idea that for you in your head, you're like, this is the biggest thing about me. And I talk to my students about that all the time, that we tend to view mental health disorders as being this all encompassing thing. Even in the way that we use language, we often don't talk about the people with the disorders. We label people by their disorders and we forget that they're musicians and their brothers and they're artists and they like to eat pizza and they're talented in this way, and they're funny in this way. And I think to hear your friends sort of be like, oh yeah, okay, this is another part about you. It sounds like it removed some of the weight of it, some of the weight of feeling like, oh my goodness, I have this big secret thing that maybe is shameful and maybe, uh, people are going to view me differently after I tell them, yeah.

David Adam: It went away. It evaporated. So this is the thing about sometimes people say, oh, did writing the book help you with your OCD? And they say, well, it doesn't help with the direct symptoms of OCD because why would it? If it was that easy, no one would have OCD. It's a medical issue, it needs medical help. But because I hadn't told anybody about it. Um, as well as the direct effect of the symptoms of OCD on me, there was an indirect effect caused by me being so secret about it, which made me feel like I was deceiving people or made me think, that I would second guess decisions that I made was making me live a parallel life thinking, what would I have done differently if I hadn't been like this? Where would I be now? What would I be doing? And that makes you feel as if a lot of your actions and your relationships are, ah, based on sort of very false foundations. There are people who I met after I had OCD, who died before I had my treatment for OCD. So the only person, the only version of me they ever knew was the person whose behavior was affected by OCD. And that really makes me sad, sad understanding to think that I never had the chance, in my view, to sort of show them the best me. Now when, um, you start talking about it, when you start telling people about it and everybody knows and I now talk to random strangers over things that took me 20 years to tell my parents, um, that side of it just evaporates immediately. So it doesn't help with the direct effects, the direct symptoms of OCD. But being honest and talking and writing about it has removed those indirect effects.

Dr. Andrea Bonior: Yeah. And that's why the work that you do in terms of speaking and writing about it is so important because it gives people a lifeline when maybe they didn't know that it existed. It can help them build empathy, but it can also help them get help if they are suffering from this themselves.

David Adam: Yes. And I think, to be honest, that's one of the reasons why I always say yes to your request and to other requests. Um, because I see the impact that people talking about it, not just me people talking about it can have. Every time when the book came out, every time I did a radio interview, my inbox, my emails just filled up with people saying, oh my God, I thought I was the only one. Every day there's someone else develops or diagnosed with a CD who didn't pay attention before. So there'll be people listening to this now who were thinking, oh my God, they're reading my mind. I didn't know anybody else ever thought like this. So I think I haven't kind of put myself out there. And it's all ironic really, because I never really wanted to raise awareness and be this kind of person who would help other people. I just thought I was a really bad role model because I kept it to myself for so long. M, uh, I thought there were people out there who were challenging their OCD as teenagers. To me that was far more, um, impressive. But it turns out there's just so few people talking and writing about this kind of stuff in a relatable way that there's an audience there for it, for sure. Yeah. Anybody listening to this now? I was, you. I was desperate for information. I was stunned that anybody else could feel the way that I did that could.

Dr. Andrea Bonior: And for those listeners, both those who might be suffering and for those who just kind of have some misconceptions about OCD, I think your point was so interesting about how some people's reaction when hearing you was, oh, yeah, I have some intrusive thoughts, too, or oh, yeah, I'm scared of HIV as well. And so maybe we spend some time sort of talking about how the intrusive thoughts of OCD are fundamentally different than the intrusive thoughts that most of us can let go of. I always use the example in my class when I'm teaching about oct that you might be sitting in the back of the class right now and you might have a random thought, hey, what if I punched Professor Bond you're in the face? And for most people, they have that random thought that's like, oh, that's a weird thought. I must be hungry, or this class must have gotten really boring today, or whatever. We let these thoughts pass. They don't seem to stick. They don't seem to upset us, and then become this repetitive, obsessive, um, intrusive cycle. So would you mind taking a little time and sort of talking about the difference between the random thought of somebody without OCD who says, oh, HIV is scary, I hope I don't get it, versus the kind of cycle and trap that you found yourself in with OCD?

David Adam: Yeah, I wouldn't frame it quite in that way, because one of the things that really helped me in therapy was the learning or believing that everybody has the same kind of thoughts, that everybody has intrusive thoughts, and that what is different is the way that I handled them or failed to handle them. So, uh, again, in the book, I describe intrusive thoughts as sort of seeds that scatter across the population. And in most people, they don't take root and they just don't do anything. But in some people, they take root and they grow into these kind of horrible OCD plants. Um, because we know that there were people throughout history who reported intrusive thoughts who didn't have OCD. And in fact, one of the only places that people talk about intrusive thoughts openly seems to be stand up comedians. They all change, allstate do you get that weird feeling when you're going to jump in front of a train or jump out of a high window? And so I think the thoughts are pretty much the same. I think, what difference is that? And again, you will know this better than I, but as I understand it, there are some psychological reasons why some people are more likely to react badly to a thought like that. And by reacting badly, I mean react at all. Rather than just sort of just dismissing it as ephemeral nonsense of the mind, we give it meaning and we try and interpret it and we try and understand it and we try and challenge it. Um, why do we do that? Well, we don't know. I think there's the honest answer, but there are certain personality types that maybe are more likely to turn these thoughts into these sort of conditions. M. And there are certain topics, if you are very religious, if you have a thought about God or the devil or Jesus or the Virgin Mary, that's going to have more, uh, resonance with you than someone who is not religious. Someone who has intrusive thoughts about finding the Virgin Mary attractive, for example, sexually attractive, which is a real intrusive thought. It's not going to bother someone who is not religious.

Dr. Andrea Bonior: Exactly.

David Adam: And so there's something about why it is pertinent for it for an individual and that's based on a whole complex tapestry of their own beliefs and personality types.

Dr. Andrea Bonior: Right.

David Adam: But I think one of the things that we know, uh, that can sort of lead one to the other is indulging them and taking them seriously. So the example I always use when I talk to people is that, um, Winston Churchill had that he had intrusive thoughts around stepping in front of a train. So much so that when the express train came through the station, he would have to stand behind a platform. He would physically put himself and let's say the next day someone does that, but they don't feel reassured enough, so they took a further step back and the next day they don't come into the station at all, and the next day they can't leave the house. Very quickly. You've gone from an intrusive thought that everybody experiences, almost everybody experiences, to something which you've almost fertilized it. You've helped it take root. Because one of the things that from an OCD perspective is that you can't out think a thought. When you get one of these really weird thoughts and you can't make it go away, you're kind of stuck for options. So the only thing you can do is change your behavior because that's the only thing that you have any control over. Which is why you get so many of these really what uh, look, really odd rituals. There's no logical reason why someone tapping three times on a wall would stop them feeling bad about the thought about someone dying, but it just makes them feel better, so they keep doing it and then it becomes locked in as this cycle. So yeah, that was a very long answer to your question.

Dr. Andrea Bonior: Not at all. Not at all. And it's so powerful to hear you talk about it from a first person perspective because I think conceptually, that's how we think about it, these thoughts sort of taking root. And a lot of my work with acceptance and commitment therapy and mindfulness cognitive behavioral therapy techniques is about allowing thoughts to not get sticky. Right. And I see it that same way. There's a big difference between a thought that passes and doesn't create this cycle of distress about the thought versus the thought that takes root. It starts to grow. As you said. It's the seed that then sticks and it grows roots. And guess what? Now it's a lot more formidable. And the person who has the passing intrusive thought about the train, they're still showing up the next morning to ride, whereas the person who's trapped in this cycle, as you said, now it starts to affect your life. You can't go on the train anymore. Or you might have developed such a complicated ritual before going on the train that it's taking hours out of your day or whatever it might be. So when you were diagnosed, did treatment immediately follow from that? Did you have stops and starts with treatment?

David Adam: So it's kind of a long story. The short version is that I first went for help in the mid ninety s, and um, uh, I got an elastic band. That was my treatment. It was called thought stopping.

Dr. Andrea Bonior: Thought stopping techniques, yeah.

David Adam: And then the idea was that it was based on the behavioral psychology of, um, everything is learned, even bad behavior. And so every, uh, time I had one of these thoughts, I was supposed to snap an elastic band against my wrist because that would then I would learn to associate that pain or that shock with the thought it didn't work.

Dr. Andrea Bonior: Spoiler alert. I know, for our listeners, that is no longer thought of as being so helpful.

Um, and, um, fast forward to: 1015

Dr. Andrea Bonior: Right.

David Adam: Um, whereas now I still take them. I first had the therapy over ten years ago, and I still take the drugs even today.

Dr. Andrea Bonior: Yeah, but oh, it breaks my heart though, that still there was such a length of time between even getting the OCD diagnosis or getting some type of pseudo treatment. In the beginning with the rubber band, before getting like, something….

David Adam: It was entirely my own fault. I kind of knew that there was or I came to know that there was a different treatment available, that I hadn't had the best option, and essentially I was too cowardly to take it. I thought I'll leave it there just in case things get really bad. Because I knew that if I tried it and it didn't work, I was completely out of options. Whereas I thought I could always sort of an emergency brake glass, um, and reach for it. And it wasted years, basically.

Dr. Andrea Bonior: Yeah. At the time, it provided, you some sort of comfort to think, well, there's still this thing that could work better.

David Adam: But then it's a long story, but ended up bottoming out. And I think, right, this has to end right now. And I went for the treatment, and luckily for me, it worked.

Dr. Andrea Bonior: Yeah. Can you talk about the specific cognitive behavioral treatment? I don't know. It was exposure and response prevention.

David Adam: Yes, it was. Um, so because mine, at this stage, it was almost all around, um, blood. I was sort of affected blood everywhere. Um, it was quite difficult to recreate. Um, so it was things like, um, at the time, I was having intrusive thoughts around blood, uh, my own blood. And I had children and babies, and essentially what I was told to do was just not perform the compulsions. So it was very hard for me to artificially trigger the obsessions, because you can't go around smashing blood on people. But I was just told, essentially my way of dealing with it was when you have one of these, um, exposures that come naturally, just don't perform the compulsions, which it sounds so obvious and so easy, but of course, through the weeks, I would try it, and it wouldn't work. And we'd talk about it, and they would give me, uh, mental tips to try and help me. And what helped weirdly, and I'm not proud of this at all, what helped me the most was when, um, the therapist basically took responsibility for it. He said, one of the things I'd worried about was if I cut myself shaving, was I might get infected blood into my baby's eye, or something like that. And he said, I want you next time you cut yourself shaving to let your baby touch you where you've injured yourself. And she will get blood on her, uh, fingers, and you will find that difficult, but this is what I want you to do. And then he would say, I've got a well paid job. If your daughter gets AIDS because of this, it's my fault, and I'll lose my job. Do you think I would do anything that would make you lose my own job? And weirdly, because he took kind of responsibility for it, it helped me to be able to I didn't actually do it, but it helped me to understand a bit more about where the blind spot was. I think this is one of the interesting things about OCD, is that I do occasionally have intrusive thoughts around things like leaving the iron on and burning the house down. Um, but I never have those intrusive thoughts about my wife doing it. And she's probably more likely to do it because when I'm away for a work or I'm away with friends for a weekend or a week or whatever it is, it's not my responsibility to make sure the house doesn't burn down. So there is this context around it, right?

Dr. Andrea Bonior: And I think that context speaks so much to the idea of guilt, oh my goodness, if this happened on my watch, then it's intrusively even more bothersome because this would be something that I did. And it speaks to that sense of control and how when it's somebody else doing it, it's kind of not your problem to the extent. Obviously you don't want your wife burning down the house, but there's not that sense of mental responsibility, of mental weight. So, yeah, for listeners, the idea of exposure and response prevention is to be exposed to the intrusive thought or the obsession, and then to have that response that you would typically have to have that prevented. That's where the response prevention comes in, or the ritual prevention that we would also sometimes say. And I wonder for you, it is such an interesting conundrum, because with the blood related obsession, it automatically means that it's going to be harder, like you said, to sort of get those exposures in. But have you heard from other people where it's a little bit simpler that whatever their obsessions, are they're able to go into a therapist's office that first day and be able to have some exposures?

David Adam: Sort of, yeah. I had group therapy, so I got to hear a lot about other people's exposures and what they were asked to do. And I mean, there was an example, this is a real example, it's going to sound as if I've made it up, but I really haven't. There was a lady in my group therapy who she also was having intrusive thoughts around HIV, and she was worried about passing it on to her husband. And so, um, her homework, if you like, her exposure was, uh, to go and go home and have sex with her husband. And she'd have to come in the next week and say how many times she managed to go and have sex with the husband. Because it makes sense she was worried about passing on HIV to her husband, so she had to do what she was frightened of. I suppose that was the exposure. And then I guess her response would have been to go and get tested for HIV or whatever and she was prevented or she was told not to do that.

Dr. Andrea Bonior: Um, so there's an example, yes, that makes perfect sense. And of course, not happening in the therapy room, but that one's much more accessible within the marital home. It really speaks to the importance of loved ones, and specifically the importance of loved ones not participating in the reassurance. I wonder if you could speak to that a little bit. Even if somebody's not in official treatment, if somebody's got some of this symptomology, how can loved ones resist the well meaning urge to say, oh, okay, well, you don't have to go to that place then. I think we do this especially as parents. If a kid is having OCD symptomology, we sort of provide the reassurance over and over and over again, oh, no, you're not going to get sick from that, or whatever we're saying. And we don't realize that we are keeping that cycle of their compulsion going, or we're letting their compulsions continue. Because quite frankly, it seems cruel to have the person go through the distressing obsession and not be able to enact the compulsive behavior. How can loved ones manage that? And how can we empower them to not be part of the problem?

David Adam: I think it's a really tough question because I think if you are the parent of a child with OCD and they take an hour to leave the house because they have to check all the windows are closed, I can well imagine it would be convenient, and, uh, not just convenient, essential to say, look, don't worry about it. I'll check the windows. Or I've checked them, and they're fine. Let's go. Rather than saying what you're going through, is irrational. I think every kind of family has to sort of deal with that balance in their own way, but with the knowledge that it's not going to get any better while you're doing that. And, um, the other thing to say though, from the patient's point of view, is that we are really devious OCD patients. We will find reassurance and we will sneak it in even though we know it. So when I was having therapy, they would say, how's your week been? And I would describe some of the intrusive thoughts that I'd had waiting for someone to say, oh, that's silly, wasn't it? That was my reassurance. Now, so my wife knows, obviously, about the OCD and she knows the general content. But what I do is I now have to say to her, look, I'm having an OCD moment. I'm worried about something. I'm not going to tell you what it is because if I tell her, I don't know, I scratched my finger on a nail, I was worried that was blood on the nail, she would just say, oh, well, that's silly, isn't it? There's no risk that will be getting reassurance. So not only are kind of family members and friends have to be aware of their own behaviors and voice and actions around people with OCD, very cruelly. They have to be on alert for the way people are trying to get them to sort of inadvertently give them that reassurance.

Dr. Andrea Bonior: Yes, it's so interesting that you put it that way, but I've certainly seen those behaviors sometimes, uh, in clients who have struggled with this, because basically you're looking for that comfort in any way possible. And so if you have to sort of do it in a way that you're not, quote unquote, supposed to, the urge to get that comfort is still so overwhelming that you're going to break the rules of the treatment a little bit and try to do it. And that's why, yeah, ideally, having the family on board is so important.

David Adam: I think just coming back to what you said. I think what I would say is that anybody who is having any kind of treatment needs to tell those they live with and their loved ones. And even if you're not, I think none of this is helped by putting barriers or communication barriers.

Dr. Andrea Bonior: So true. And we see that across the board. Folks that get treatment for eating disorders, and then they go right back into the same home scenario that they had before, with the same weird emotional baggage at the dinner table and the same M comments and all of these things. And I think so much of it is really having the ability to be vulnerable and say, this is what I'm going through, and here's what I need, and here's how you can help. So I see so many myths out there as a psychologist about OCD. Are there ones that sort of stick in your mind that you've been able to help dispel these misconceptions out there in the public since writing your book?

David Adam: I think the one that does the most damage is the classic cliche that OCD is just a behavioral quirk and can even have positive outcomes. There was a terrible TV program over here, OCD Cleaners, where they would get people with OCD to come and clean your house, because in theory, people with OCD really like cleaning and are really good at it. And there are also, as you will come across, cliches around people with OCD liking things balanced and symmetrical and ordered. And the danger with that is that so people with OCD get their information the same place as everyone else's. So if you grow up thinking OCD is around tidying your record collection or balancing your socks, and when you start having these intrusive thoughts about HIV, or about hurting people, or about hurting yourself, you think, well, what's wrong with me? Because it is an OCD, you put an extra level of extra, uh, hurdle in the way of people from seeking treatment. I'm not as critical of people using OCD in that way as some people, because I think it's ignorance, but it's kind of a pure ignorance. This is what people think it is. It's not meant to be malicious. And I like to think that we're somewhere along the path that we were with using the term schizophrenia. When I was growing up, schizophrenic was used to mean split personality. Uh, and it was applied to things like, I don't know, a soccer, uh, team that had a very good offense and a very poor defense was a schizophrenic team because it had this. And I think we've grown beyond that now. I think most people know that isn't what it's about, but yet you almost have to be familiar with the term to start with. So I think the fact that OCD is out there and everyone kind of is familiar with the term, uh, is a decent platform, and then usually once you point out to people that actually that's not what OCD is, mostly oh, God, I have no idea. I'm so sorry. And then hopefully, they won't do it again.

Dr. Andrea Bonior: Yeah. And it won't become this slang that you see on social media. Oh, I'm bothered by things being uneven, therefore I have OCD. And it's that simple. Well, David, it's been so wonderful to talk with you today, and I really appreciate you taking the time. And I know that people find a lot of help in your book, and so thanks for all the good you're putting into the world for others as well.

David Adam: You're very welcome. Thank you very much.

Dr. Andrea Bonior: Thanks for joining me today. Once again, I'm Dr. Andrea Bonior, and this has been Baggage Check, with new episodes every Tuesday and Friday. Join us on Instagram @baggagecheckpodcast. Give us your take and opinions on topics and guests. And you know you've got that friend who listens to, like, 17 podcasts. We'd love it if you told them where to find us. Our original music is by Jordan Cooper, by Daniel Merity, and my studio security, it's Buster the Dog. Until next time, take good care.