Caring too much, compassion, and letting others pull you out of the hole
On my Twitter newsfeed this week, I spotted Danny Whitaker's podcast
on Maternal OCD with renowned expert Dr. Fiona Challacombe, a research
fellow and clinical psychologist working at Kings College London and the
Maudsley Centre for Anxiety Disorders and Trauma who is Patron of the UK
Charity for OCD and its impact on mothers, Maternal OCD.
I knew I had to hear this. I wrote to Dr. Challacombe back in 2012, 28 weeks pregnant, recently diagnosed with perinatal OCD. Those emails are the only record I have of my thinking at that time.
They are still not easy to read:
Superstitiously, I believe that this "negative" thinking [that my baby will die and it will be my fault] is me being ungrateful for all that is good in my life and that I will deserve whatever catastrophic outcome comes my way because I will have brought it on by "troubling trouble before it troubles you".
I can see that thinking these things does not keep me, my son or my baby safe. I see these thoughts as weak, disgusting and selfish and also that they [relate to my history] of repeatedly saying "whatever you did to me, it's okay because you were suffering much more than me. If you really see that I am truly here for you and okay with what you were doing, maybe you will hurt less, and then you will stop hurting me".
My
question is if I "get" this but it doesn't change my
behaviour, how on earth am I going to get through the next 8/9/10
weeks? I am so worried that I am harming my baby by having so much anxiety. My
consultant says it may not reduce before the labour and I am just distraught
about this, and becoming increasingly desperate to find a solution. I think I
am at the stage I would try anything.
Even now, I feel these words in my body, in my heart and in my belly. These words prickle at the back of my eyes, they linger in my throat, I feel them as the dryness in my mouth and the shake in my hands, the tremble in my lips.
Long ago, I used to believe that the power of voicing your own story could ease all pain, remove all suffering. The truth I hear now in the pain of my own words is somewhat different.
Sometimes, even with well-developed skills to communicate the story of our pain and its history, we can be absolutely paralysed in moving our feet in a different way. We sometimes need the support of others who can see our story from a different place. We sometimes need others to redirect us when we have gone off path.
This is simply the kind of animal we are: we all get stuck, we can’t always unstick ourselves easily and sometimes we need more help than others. Sometimes we needs lots of help from lots of others!
Now, I hear and feel my pain. Then, I could not. Little did I know then how much hiding from it hurt and maintained it.
At the recent Association of Contextual Behavioural Science World Conference, Acceptance and Commitment Therapy co-creator Steven Hayes spoke about human yearning and its relationship to pain.
Pain is a universal human experience, and can serve as a useful indicator of what matters to us in life. When emotional pain is misdirected, however, it can radically narrow the ways in which we behave in the world.
One example of such misdirection is cognitive fusion, where thoughts feel so palpable and real that your body and mind react to them as though, in themselves, they are as dangerous as any wild animal baring its teeth, ready to claw you to death and consume your remains.
This experience of fusion is particularly relevant to OCD. Hayes suggests it may arise when our deep human yearning for coherence (or understanding and making sense of things) creates in us conditions for excessively literal, “small” and restricted ways of responding to our world. In our desperate search to solve the problem that we so easily perceive as being the whole of our life in a given moment, or simply, our scrambling efforts to access a way of being or feeling “right” or "certain" or "safe", we can find ourselves putting our life on hold while we battle difficult thoughts, emotions and sensations in specific, and often unhelpful, ways: deliberately thinking or doing a small range of things to stave off feelings of unease, terror, anxiety and panic.
The solution? Hayes suggests it comes when we can mindfully step back, see this movement of mind as a flow of energy, and redirect this to learning what works in our life in a mindful, flexible, values-oriented way. When we can do this, he argues, we can think more flexibly, and achieve a greater sense of the broad meaning of our life: touching the greater wisdom of consciousness, what lies behind the eyes.
Sounds easy, doesn't it? Even writing this, I am reminded of the frustration I used to feel when I read stories of recovery that promised me it was possible.
"Let go of your anxiety, like you might let go of a stone" - but how? That used to haunt me. When your mind is fused and your muscles of acceptance and kindness to your more difficult experiences are underdeveloped or even absent, such advice can feel as unrealistic as being asked to take flight. (See this excellent podcast where Steve describes this in much greater detail).
Yet, if I have learned anything on my OCD journey, it is this - there is more to me than my mind, but my mind is never going to want me to believe that. This is one important reason that we cannot always navigate the challenges presented by our tricky, suffering minds alone.
Reaching out to others and figuring out together what you can’t make sense of can be extremely helpful in releasing the pressure of the problem-solving mind, and loosening the stranglehold of too much sense-making. For many of us with OCD, approaching this with brutal honesty and saying what we fear is one of the most important steps in recovery, especially with minds SCREAMING that speaking our thoughts is tantamount to committing a crime. Reaching out in this particular way - not compulsively to seek reassurance but vulnerably to seek support in finding a different way forward in life - is an act of extreme courage. It is often one of the first steps to accepting that you can't know, before you do it, how it will feel or what its consequences will be.
When I found the courage to write to Dr. Challacombe all those years ago to volunteer for a study she was running, it so happened I was lucky first time, and she heard what I couldn’t in my
fusion.
What she heard, loud and clear, was the misdirection of pain, and an underdeveloped repertoire of responding with kindness to my own experiences:
Of course what you experienced wasn't right - you should not have had to support any behaviour unconditionally - no one should. However, just knowing this is often not enough and this is a common problem - we sometimes call it a head/heart lag.
Viewing the thoughts and/or your responses to them (and by extension yourself) as weak disgusting and selfish is going to fuel the OCD in a number of ways - self attacking is not going to help your mood and keeps the idea that thoughts are important going. For what it's worth, like you, I do think it makes sense that those feelings are there but at the same time I disagree vehemently - you are clearly trying to do the best for your baby which is really the opposite of these things.
I think that you could try exploring self-compassion which means "truly understanding and supporting yourself" through this problem.
This one small suggestion has made all the difference. Small actions have big ripples.
In the intervening years, I have had lapses (and more recently, my first full actual relapse since my official diagnosis and treatment) and yet I am still exploring - these days, with less and less striving, less illusion now this will be anything other than the journey of a lifetime, more and more tender-hearted awareness of the inescapable burden of carrying pain in this human life. It is still not easy and yet I am here, I am alive, and I do not live caged by my mind the vast majority of the time. Most importantly, I am being the mother I want to be. I love and am loved as I always yearned for. It is still hard and it is so very worth it.
Listening to the recent podcast five years on, I find myself deeply touched by hearing the experience of perinatal OCD (one shared by 1-3% of mothers), something I once believed to be so gravely shameful and cursed, described with such understanding and compassion:
You know, what we know about this problem, is that it’s a problem of really caring a lot, it’s a problem of caring too much when it comes to kids, that’s what the OCD is harnessing. So it’s not about not being bonded, it’s about just being so alive to all sorts of threat that it’s got you doing all sorts of things which you don’t need to be doing.
In those words today, I hear something very important, though I would not have heard it then.
We can sometimes care too much. This very caring - this desire to prove and show and test and retest our love for our children or others - can make us do things that we don't need to do: to feel right again, to feel safe to care for our children or others we love, to feel our children and others we love can be safe in our care. We care too much, and we trust too little.
What Maternal OCD asks of us is to be brave, to open to the possibility that we can love freely and truly without it breaking us or those we love: that this, in fact, is not only the way we truly want to love, but the only way to love.
Perhaps for some of us, there are stories in our histories, stories that don't make sense, that make it hard to believe in love without pain, love without caution. Yet, if this is where you are, I can promise you this, the only way to heal those wounds and to love as you deserve is to meet them head-on, with deeply fierce, deeply compassionate courage.
I can promise you this, and yet I know even as I do, there is a very good chance you will not believe me. You will not believe me until, shaking and broken and feeling at the very end of all things, you find within yourself the courage to walk towards the things that scare you the most, look them in the eye, feel them in your marrow and open to the tiny whisper behind all of this, that this is so very hard, and so very human, and you - yes, you! - are as deserving as all others to stand with and for yourself in meeting it. You are as deserving as those you love and are so desperate to protect - and you always were.
It is true, no one can tell you with words how to overcome this, and yes, there are actions in overcoming this that only you can initiate, only you can do (or choose not to do, as is the case for many of us) - but please, don't keep trying to do it in silence, don't keep trying to do it alone. Though not everyone will or can hear, there are those who will and if you persevere, you will learn that it truly is #okaytosay. This will make all the difference. You are stronger than you believe and we all sometimes need to be pulled out of the holes in which we find ourselves. Reach out, take any hands that are offered, take some support. There is a world beyond the cage you find yourself peering from and it is more vast and more beautiful than you dare dream. Don't take my word for it, though. You can only know this one by doing it.
Useful Links and Readings:
Maternalocd.org
Postpartum Progress - For all Perinatal MH conditions
The Joy of Parenting: An Acceptance and Commitment Therapy Guide to Parenting in the Early Years
Dropping the Baby and Other Scary Thoughts
The Pregnancy and Postpartum Anxiety Workbook
I knew I had to hear this. I wrote to Dr. Challacombe back in 2012, 28 weeks pregnant, recently diagnosed with perinatal OCD. Those emails are the only record I have of my thinking at that time.
They are still not easy to read:
Superstitiously, I believe that this "negative" thinking [that my baby will die and it will be my fault] is me being ungrateful for all that is good in my life and that I will deserve whatever catastrophic outcome comes my way because I will have brought it on by "troubling trouble before it troubles you".
I can see that thinking these things does not keep me, my son or my baby safe. I see these thoughts as weak, disgusting and selfish and also that they [relate to my history] of repeatedly saying "whatever you did to me, it's okay because you were suffering much more than me. If you really see that I am truly here for you and okay with what you were doing, maybe you will hurt less, and then you will stop hurting me".
SO
Even now, I feel these words in my body, in my heart and in my belly. These words prickle at the back of my eyes, they linger in my throat, I feel them as the dryness in my mouth and the shake in my hands, the tremble in my lips.
*****************
Long ago, I used to believe that the power of voicing your own story could ease all pain, remove all suffering. The truth I hear now in the pain of my own words is somewhat different.
Sometimes, even with well-developed skills to communicate the story of our pain and its history, we can be absolutely paralysed in moving our feet in a different way. We sometimes need the support of others who can see our story from a different place. We sometimes need others to redirect us when we have gone off path.
This is simply the kind of animal we are: we all get stuck, we can’t always unstick ourselves easily and sometimes we need more help than others. Sometimes we needs lots of help from lots of others!
Now, I hear and feel my pain. Then, I could not. Little did I know then how much hiding from it hurt and maintained it.
At the recent Association of Contextual Behavioural Science World Conference, Acceptance and Commitment Therapy co-creator Steven Hayes spoke about human yearning and its relationship to pain.
Pain is a universal human experience, and can serve as a useful indicator of what matters to us in life. When emotional pain is misdirected, however, it can radically narrow the ways in which we behave in the world.
One example of such misdirection is cognitive fusion, where thoughts feel so palpable and real that your body and mind react to them as though, in themselves, they are as dangerous as any wild animal baring its teeth, ready to claw you to death and consume your remains.
This experience of fusion is particularly relevant to OCD. Hayes suggests it may arise when our deep human yearning for coherence (or understanding and making sense of things) creates in us conditions for excessively literal, “small” and restricted ways of responding to our world. In our desperate search to solve the problem that we so easily perceive as being the whole of our life in a given moment, or simply, our scrambling efforts to access a way of being or feeling “right” or "certain" or "safe", we can find ourselves putting our life on hold while we battle difficult thoughts, emotions and sensations in specific, and often unhelpful, ways: deliberately thinking or doing a small range of things to stave off feelings of unease, terror, anxiety and panic.
The solution? Hayes suggests it comes when we can mindfully step back, see this movement of mind as a flow of energy, and redirect this to learning what works in our life in a mindful, flexible, values-oriented way. When we can do this, he argues, we can think more flexibly, and achieve a greater sense of the broad meaning of our life: touching the greater wisdom of consciousness, what lies behind the eyes.
Sounds easy, doesn't it? Even writing this, I am reminded of the frustration I used to feel when I read stories of recovery that promised me it was possible.
"Let go of your anxiety, like you might let go of a stone" - but how? That used to haunt me. When your mind is fused and your muscles of acceptance and kindness to your more difficult experiences are underdeveloped or even absent, such advice can feel as unrealistic as being asked to take flight. (See this excellent podcast where Steve describes this in much greater detail).
Yet, if I have learned anything on my OCD journey, it is this - there is more to me than my mind, but my mind is never going to want me to believe that. This is one important reason that we cannot always navigate the challenges presented by our tricky, suffering minds alone.
Reaching out to others and figuring out together what you can’t make sense of can be extremely helpful in releasing the pressure of the problem-solving mind, and loosening the stranglehold of too much sense-making. For many of us with OCD, approaching this with brutal honesty and saying what we fear is one of the most important steps in recovery, especially with minds SCREAMING that speaking our thoughts is tantamount to committing a crime. Reaching out in this particular way - not compulsively to seek reassurance but vulnerably to seek support in finding a different way forward in life - is an act of extreme courage. It is often one of the first steps to accepting that you can't know, before you do it, how it will feel or what its consequences will be.
**************************
What she heard, loud and clear, was the misdirection of pain, and an underdeveloped repertoire of responding with kindness to my own experiences:
Of course what you experienced wasn't right - you should not have had to support any behaviour unconditionally - no one should. However, just knowing this is often not enough and this is a common problem - we sometimes call it a head/heart lag.
Viewing the thoughts and/or your responses to them (and by extension yourself) as weak disgusting and selfish is going to fuel the OCD in a number of ways - self attacking is not going to help your mood and keeps the idea that thoughts are important going. For what it's worth, like you, I do think it makes sense that those feelings are there but at the same time I disagree vehemently - you are clearly trying to do the best for your baby which is really the opposite of these things.
I think that you could try exploring self-compassion which means "truly understanding and supporting yourself" through this problem.
This one small suggestion has made all the difference. Small actions have big ripples.
In the intervening years, I have had lapses (and more recently, my first full actual relapse since my official diagnosis and treatment) and yet I am still exploring - these days, with less and less striving, less illusion now this will be anything other than the journey of a lifetime, more and more tender-hearted awareness of the inescapable burden of carrying pain in this human life. It is still not easy and yet I am here, I am alive, and I do not live caged by my mind the vast majority of the time. Most importantly, I am being the mother I want to be. I love and am loved as I always yearned for. It is still hard and it is so very worth it.
Listening to the recent podcast five years on, I find myself deeply touched by hearing the experience of perinatal OCD (one shared by 1-3% of mothers), something I once believed to be so gravely shameful and cursed, described with such understanding and compassion:
You know, what we know about this problem, is that it’s a problem of really caring a lot, it’s a problem of caring too much when it comes to kids, that’s what the OCD is harnessing. So it’s not about not being bonded, it’s about just being so alive to all sorts of threat that it’s got you doing all sorts of things which you don’t need to be doing.
In those words today, I hear something very important, though I would not have heard it then.
We can sometimes care too much. This very caring - this desire to prove and show and test and retest our love for our children or others - can make us do things that we don't need to do: to feel right again, to feel safe to care for our children or others we love, to feel our children and others we love can be safe in our care. We care too much, and we trust too little.
What Maternal OCD asks of us is to be brave, to open to the possibility that we can love freely and truly without it breaking us or those we love: that this, in fact, is not only the way we truly want to love, but the only way to love.
Perhaps for some of us, there are stories in our histories, stories that don't make sense, that make it hard to believe in love without pain, love without caution. Yet, if this is where you are, I can promise you this, the only way to heal those wounds and to love as you deserve is to meet them head-on, with deeply fierce, deeply compassionate courage.
I can promise you this, and yet I know even as I do, there is a very good chance you will not believe me. You will not believe me until, shaking and broken and feeling at the very end of all things, you find within yourself the courage to walk towards the things that scare you the most, look them in the eye, feel them in your marrow and open to the tiny whisper behind all of this, that this is so very hard, and so very human, and you - yes, you! - are as deserving as all others to stand with and for yourself in meeting it. You are as deserving as those you love and are so desperate to protect - and you always were.
It is true, no one can tell you with words how to overcome this, and yes, there are actions in overcoming this that only you can initiate, only you can do (or choose not to do, as is the case for many of us) - but please, don't keep trying to do it in silence, don't keep trying to do it alone. Though not everyone will or can hear, there are those who will and if you persevere, you will learn that it truly is #okaytosay. This will make all the difference. You are stronger than you believe and we all sometimes need to be pulled out of the holes in which we find ourselves. Reach out, take any hands that are offered, take some support. There is a world beyond the cage you find yourself peering from and it is more vast and more beautiful than you dare dream. Don't take my word for it, though. You can only know this one by doing it.
Useful Links and Readings:
Maternalocd.org
Postpartum Progress - For all Perinatal MH conditions
The Joy of Parenting: An Acceptance and Commitment Therapy Guide to Parenting in the Early Years
Dropping the Baby and Other Scary Thoughts
The Pregnancy and Postpartum Anxiety Workbook
Hi Fiona...well done for being so open and so brave. Your article reads with a gentleness to your experience, which Im guessing was very different from when you were first struggling. Such an important practice to be gentle and the compassion you've developed shines through. I'll make a note of this article and share with those I think it will help. More resources like this needed to support all women adjusting to pregnancy and motherhood. Thank you, Jim
ReplyDeleteThanks very much for your kind words, Jim. Indeed it was anything but gentle then and often still isn't. Speaking kindly to it is, as I know you know, an ongoing practice. I really appreciate your encouragement and that you took the time to comment. Warmly, Fiona.
DeleteHi Fiona, thanks for this really wonderful blog. A couple more resources I'd strongly recommend, in particular as you've highlighted ACT for OCD:
ReplyDeletehttp://becomingmum.com.au/ - the only ACT for perinatal self help book yet in print.
http://www.koawhittingham.com/ - Becoming Mum's author's page
http://www.mindthebump.org.au/ - useful mindfulness app for new mums.
warm wishes
Rob
Dr Robert Purssey
MBBS FRANZCP
Psychiatrist and ACT Therapist
Director - Brisbane ACT Centre
Thanks Rob! These are excellent resources to share. I will add them to the list.
DeleteBrilliant. Thank you!
ReplyDelete:) Thanks for your comment Gonzalo Brito!
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