Tuesday, March 22, 2011

Katie L and Doubt: the story of a Mormon girl with Pure-O (part I)

Hi friends! This Depression Profile is actually in two parts and is not exactly about depression. A wonderful woman, Katie L, contacted me and told me about her years of struggle with Pure-O OCD and the effect it had on her spirituality as a Mormon. (While this lady was not clinically depressed her struggles did lead to some depressive episodes.) Pure-O OCD is a (somewhat disputed) anxiety condition where the sufferer obsesses about unwanted, intrusive thoughts without any recognizable or outward compulsions. For me this kind of obsessing was the defining factor of the postpartum period with my first child. It's also how I know when I am on the brink of a breakdown. Having experienced a version of this myself, I really appreciate how Katie L. describes this. Her writing is vivid and the information she gives important. For more info on Pure-O check out the website The Other OCD or the books The Imp of the Mind by Lee Baer, Brain Lock: Overcoming Obsessive-Compulsive Behavior by Dr. Jeffrey M. Schwartz, and When in Doubt, Make Belief by Jeff Bell.

Name: Katie L.
Location: Pacific Northwest
Age: 29
Religion: Mormon

I can't remember a time in my life when I didn't struggle with anxiety. It became more pronounced around the age of nine, though. Before then, I'd feel very guilty about things I did wrong and make conscientious attempts to avoid sin; by the age of nine, my flirtation with guilt and doubt had blossomed to a full-blown romance.
OCD is sometimes called "the doubting disease," and that description resonates deeply with me. From 9-years-old on, I not only experienced doubt about things that are "normal" to doubt -- such as the existence of God or the truthfulness of the Church (though perhaps the severity was abnormal for someone so young) -- but I also began to have very strange doubts. For example, I would feel guilty for doing something and then feel unsure about whether or not I actually did it.

I developed a fairly severe confession compulsion. Whenever I did something wrong, I confessed it to my mother. If I wasn't sure whether or not something I'd done was actually wrong, I confessed it anyway, just in case. Sometimes, questions arose about who had done one thing or another -- who broke the scooter in the basement, who took Dad's quarters off the dresser, who made a mess in the laundry room -- and I confessed, even though I had no recollection of doing it.

Eventually, my mother caught on that something wasn't quite right. We didn't have enough information to call it OCD, but it became okay for me to say, "I don't know if I did it or not!" Although I imagine that some parents would have assumed that their child was trying to get out of punishment, somehow my mom understood that I was being honest -- I really wasn't sure -- and she didn't press me on it. In fact, she often reassured me that I probably hadn't committed the crime in question.

I also found myself praying constantly. I prayed for forgiveness. Unwanted thoughts about the truthfulness of the church would trouble me, so I prayed for a stronger testimony. I prayed to "know" whether or not I had actually committed the sins I worried about. I prayed for help overcoming my weaknesses, both real and imagined.

As I grew older and learned about sex, I became troubled with disturbing sexual images that would flash through my mind frequently (well, disturbing for a scrupulous pre-teen; I realize now they were pretty tame).
[Laura's note: scrupulosity is a technical term for a moral or religiously fixated OCD. What Katie L describes above is a quintessential definition. For more on scrupulosity check out this scrupulosity blog and this article from Catholic Culture or the book Devil in the Details, about a girl growing up Jewish and with OCD.] For a period of about a month when I was 10 or 11, I refused to take the sacrament, because I believed I was unworthy due to "dirty thoughts." I feared that by partaking of the sacrament I would eat and drink damnation to my soul. (Finally my mom asked what was going on, and when I told her, she said it was okay to take the sacrament even if you couldn't completely eliminate bad thoughts from your mind, because that's what the atonement is all about.)

I began to fear the Second Coming because I believed that I would be cast into the fire due to the intrusive obsessions and my inability to be perfectly clean. I started begging God to wait to send Jesus until I was worthy, to give me enough time to properly repent of my sins.

As I've gotten older I've found that Doubt targets whatever is the most important to me. For example, in my late teens, I fell in love for the first time and began to think of myself as a sexual person who could be attractive to men. So OCD hit me there: I developed an obsession about my sexual orientation (this is different from real homosexual attractions or sexual curiosities; what I experienced were overpowering fears that one day I would wake up and suddenly "discover" I was gay).[Laura's note: H-OCD is a subset of OCD where the sufferer worries that they are actually gay but don't know it or that they have somehow done something that makes them gay but don't remember it. Often it takes the form of obsessing over the fact that the individual cannot ever remember being not-gay, not just straight but not-gay--a distinction that really only makes sense in the context of OCD. For more information on understanding the difference between sexual orientations and HOCD check out this website, Gay or Obsessive-Compulsive Disorder:Homosexual fears and OCD. Please, please, please don't think this is a comment on sexual orientation; it's not.]

On my mission, my doubts about the truthfulness of the church intensified to near-deafening levels. I found myself agonizing over the use of "you"-pronouns in the Book of Mormon -- did it use "ye" vs. "thee" properly? I struggled with feelings of unworthiness, and questions as to whether or not I had done bad things arose again. I confessed several non-sins to priesthood leaders on at least five separate occasions.

When I was pregnant with my daughter, I began obsessing that I might harm her after she was born. That's when I finally checked myself into therapy -- I simply could not bear those thoughts, nor their implications.
These days, although my symptoms are much milder thanks to effective treatment and a softer worldview that I've worked consciously to develop, I continue to struggle with obsessive thoughts. Lately, they tend to focus around whether the people I am close to "really" love me, the veracity of my religious beliefs (this one dies hard), and whether the food I'm about to eat is going to make me sick.

On my worst days, the obsessions are so overpowering that I think about little else. My stomach is in knots. I spend the day praying, checking things online, seeking reassurance -- and, of course, ruminating. Rumination involves trying to solve whatever unsolvable problem is in front of me, an attempt to "think" myself out of Doubt. Since I'm "Pure-O," this is by far my most consuming compulsion.

Because my compulsions are primarily mental, unless it's a really, really bad day, it's easy to hide my disorder. This is both a blessing and a curse. It's a blessing because there are often legitimate reasons why you might want to keep something like this private. But it's a curse because it isolates you. For example, for years my husband -- yes, the dude I live with every day! -- had no idea I struggled with anxiety because I was so skilled at hiding it, so adept at going through the motions of daily life, even while I was suffocating in Doubt's stranglehold.

I have had perfectly normal, funny, seemingly carefree interactions with people, while inside my mind and stomach are absolutely churning. I have often excused myself from a class, meeting, or conversation to retreat to the bathroom, drop to my knees in anguish, beg God to take it away -- and then stand up, look in the mirror, put my smile back on, and return to face the world.

That's a terrible way to live. I don't recommend it.

[Laura's note: Please come back and read part II. I promise this story has a better ending!!]


Katie L. said...

Thanks for posting this, Laura!

For the record, and as I mentioned in the post, I agree with the PDF you linked to about "Pure-O" OCD being something of a misnomer. My experience is that OCD consists of both obsessions AND compulsions -- it's just that with what is commonly called "Pure-O" your compulsions are primarily mental in nature as opposed to primarily physical or external. For example, in response to my intrusive doubt-thoughts, I will pray, review conversations over and over, perform mental checks, spend literally hours trying to "solve" some unsolvable question, etc.

I only emphasize this because the way you get better with OCD is to prevent your compulsive response. For the "Pure-O" sufferer, this means preventing yourself from performing the mental action you want to take. In some ways it can be harder to prevent a mental response than a physical one, but it is possible.

Jessica said...

I don't even know if you will get this, since it is an older post but I will give it a shot. It is refreshing to know that there is someone out there that has had the same struggles. I have never been properly diagnosed 3 different therapists diagnosed 3 different things but after doing some research I have full blown "Pure O" and have had it ever since I can remember. My question is how do you find someone who knows how to effectively treat it? Thanks for being willing to be open and willing to share:).

J to the Radical said...

Hi Laura, I am LDS and have been inactive for a long time. Could I email you my brief story and see if maybe you can relate and offer some tips or advice? my email is jaredj311@gmail.com