Exposure
The tears are streaming down my face as my throat swells up. “I’m not anxious anymore, I’m just sad,” I tell my therapist.
I cry a lot. I’m a pint-sized butch with a lot of feelings. Or at least it feels like a lot. I rarely can make it through a fight without crying. I cry at sad movies, I cry at positive movies, I cry at nostalgic ones. I cry when I’m angry, and I cry when I’m frustrated. I do not enjoy it. I hope that I am not weaponizing my tears. Crying does not come with relief for me — mostly it just makes my eyes hurt. If I could control it, I would.
My therapist has just guided me through two exposures in her office. My insurance allows for double therapy sessions for longer exposure work. One exposure required me to cough on my hand and shake someone’s else’s hand. It wasn’t supposed to come up during the exposure that the therapist I shook hands with had a 13-week-old baby at home. But that’s what happens with exposures. You can’t plan for everything.
My therapist knew this, of course, but had kept this information from me because she knew it would make my anxiety go up. I don’t want to hurt children or infants. She didn’t intend for the other therapist to disclose in the hallway that she has an infant at home and had just come back from maternity leave. When we re-enter her office, my therapist apologizes.
“I am so sorry. I didn’t intend for that to come up because I knew it would make the level too high.”
There is something to having a medical professional tell you that you should shake hands with someone after coughing on your hand that relieves me a bit of the hyperresponsibility that goes along with my OCD. What bothers me the most about contamination fears is not actually getting sick. It’s the idea that I can’t be positively sure that I am healthy. And since I am not sure that I am healthy, it seems unfair of me to pretend as if I am. What if I get someone sick and cause them misery? My therapist tells me a story about a friend of hers who contracted hepatitis A from taking a public bus. Of course, she’s not sure if it really was transmitted from riding a bus — my brain also wonders if this friend of hers perhaps ate at a restaurant where a cook had hepatitis A. It doesn’t matter: an innocent person contracted a severe liver disease that’s highly contagious. I know I have been vaccinated against hepatitis A because we had an outbreak in my town and there are billboards with the symptoms all over the place. My primary care physician is just vaccinating everyone who comes through her office. But my OCD doesn’t care — and this story doesn’t help. The way hepatitis A spreads is like candy for my mind. I could have an illness just like that and not know about it.
My therapist is chatting about the first exposure we just did. It’s hard for me to follow her because my brain is doing other things. OCD therapists — at least this one — they talk a lot. In many ways, this is welcome. I don’t have to tell her any stories about my family or narrate my life or find out a reason for the thoughts I have. The exposures are stressful enough. This also isn’t talk therapy. It’s a completely different modality.
“Look at my hand!” I blurt out, interrupting her. I have taken my right hand, the hand I shook with the therapist next door, and I have hidden it under my thigh. I don’t ever sit like this. This is not a quirk. I have hidden my offending hand.
“Does it feel dirty to you?” she asks.
“No. It’s never a question of feeling dirty. It feels dangerous. Like a weapon.”
***
One of the things that’s helpful during this process is that after each exposure, we just mindlessly chat while we wait for the terror to come down. Peak OCD is like a shot of pure terror through your veins. Sometimes I feel like cortisol is flowing through my body, and I wonder if this is what drugs feel like to some people. There is a distinct rush. The flow of stress hormones can cause me to shake and it seems to me that I know the difference between blood flowing through my veins and how different it feels to have cortisol coursing through my body, which I imagine makes the blood move faster, but also feel thicker.
I realize this is not scientific. But I have also surprised myself sometimes in the past by diagnosing a problem from the inside, by having my own description match diagnostic or clinical criteria. Nearly twenty-five years before I was diagnosed with Ehlers-Danlos syndrome, whenever I had tendonitis, I could see and feel the space between my joints expand as tendons stretched and were unable to hold their shape. Years later, I read a newspaper article about a local woman who has the same disorder and the journalist included this very specific detail: the space between her joints is double the number of millimeters of a normal person.
When I end up with a case of triceps tendonitis in 2019, after I had been formally diagnosed, I point out the difference in my elbow joints to my doctor. As she compares my two elbows, she confirms what I can feel: “Oh, yeah,” she says, pushing around on the triceps tendon. The most validating responses from medical professionals are often the most inarticulate. “Oh, yes,” “uh-huh,” “mmm-hmmm,” “you have this”: these are actual quotes from professionals who have confirmed my diagnoses with the bare minimum of language.
“Are you ready to do another one?” my therapist asks.
“I don’t know. Do I have to shake someone else’s hand?”
“No, I won’t make you do that one again. What about touching things in the office?”
I can feel my hesitation, but I also know this is why am here.
“Yeah, we can do that,” I say.
I really don’t want to.
She lets me out of the office and I take two steps down the stairs. She’s standing behind me. She does most of the exposures that I do — it seems to be common practice that we do them together. I think she might have a related mental health diagnosis because of the way she uses a “we” in conversations. I’m queer and trans* and I am attracted to cis women — I know all of the ways that people subtly out themselves. It doesn’t matter if you’re queer or if you have some other condition or identity, outing is subtle, but if you are practiced in listening to what people say, you will notice other people’s attempts to share something with you all the time. I do something similar with students who come to see me who are markedly depressed or anxious. I frequently tell them, “Look, I don’t know you. But I have a brain that doesn’t always do what I want it to. So, what do we need to do for this course to work for you?”
I appreciate that my therapist doesn’t straight up tell me if we share a diagnosis. I would never out myself to a student in blatant terms: when they come to see me, this conversation is about them. But it would also be irresponsible to insist that I am fine and that they have a problem. Hiding my struggles only makes students feel worse. It is not impossible for them to have a mental struggle and still graduate, just like it’s not impossible for me to struggle and still do my job. I’ve seen it happen. To both of us.
Two steps down the staircase, my therapist stops. I’ve been holding the banister with my left hand.
“That’s the wrong hand,” she says. I pause. She’s right. I didn’t cough on that hand.
I started college as an acting student. In theater classes, we were trained to let our minds prompt us to follow our first instinct in any make-believe situation. It’s the instinct that creates authenticity in the artificial world of the theater. Weirdly, this instinct training kicks in right now, on a twenty-year delay. A week ago, my therapist demonstrated what it would look like to re-contaminate my hand. She licked her hand, touched the bottom of her shoe, and demonstrated all of these atypical things that normal people don’t do, but that I guess OCD therapists have agreed are unlikely to kill you.
“I am really grossing you out right now,” she had said as she demonstrated and I sank into the couch. She was totally grossing me out. But standing on that staircase, I don’t even think about it. I lick my left hand and then slide it down the banister, palm down, as I go down the stairs.
“I’m touching this right behind you!” she says, with an amount of glee that is very confusing to me. I stop at the door into the waiting room, and I realize how often clients don’t do any of the basic things that another human could do when they go to a therapy appointment. She always opens the door, she always closes the door, and there’s some level of politeness that keeps me from taking over.
“Open the door,” she says gently. We walk into the waiting room and start touching the arms of chairs. This feels so strange to me that I just take my dirty hands and plop them palm down on all of the magazines sitting on a small counter. I can’t think; I just have to do. After we touch everything, we sit in the waiting room for a second in the chairs we’ve just contaminated.
“Who came up with this?” I think. What I have just done is so bizarre that my mind is trying to think through the headspace of the psychologist who came up with this technique. It would be hilarious if it weren’t so utterly terrifying.
“You did not think that through, did you? You just went for it,” my therapist says to me as we sit, with one chair between us, in the waiting room.
“I did not think that through,” I admit, shaking my head. Someone comes into the waiting room, so she suggests we go back to her office.
My body suddenly feels shaky. We chat a little bit.
“You attacked that,” she says. “You did good!” She smiles at me.
As the stress comes down, the tears start.
I feel revolted. The feeling of transgression is the strongest, most punishing feeling that accompanies my OCD. It feels necessary at this point in the story to convince you that I wasn’t always like this. I wasn’t always hemmed in by such a severe fear of doing something horrible. I’m crying not only because my body is literally full of stress hormones, but because this ridiculous activity was so painful to me that I am also acutely aware of everything that I have lost. I am vulnerable, but I do not feel exposed. Being caught in the middle of an obsessional thought or a compulsive action makes me feel far more exposed, naked even. Those moments put my insanity on display. Showing the fact that this disorder causes me great pain — that’s just honest.
My therapist starts talking about how things will get better. About how much strength I have, given that my illness was so severe but I still never stopped being able to go to work. That I am still out in the world and doing more things. She tells me that it is unlikely that in the future things will get as bad as they did again. She has seen hundreds of clients come through and the vast majority, especially those who have good insight like I do, they acquire the tools that they need through ERP and they go on to live full lives.
I just keep crying steady tears. Ten years ago, the dyke therapist I saw after I was assaulted and stalked told me the same thing. “Things won’t get this bad next time.” Cognitively, I understand both of them to be right. Things never get bad in exactly the same way. But there will be a next time. This particular mental illness, so clearly associated with a part of the brain running a buggy program, is chronic. And this time, this particular time, I have lost a lot more. After struggling to get where I am professionally, I stand to potentially lose my source of income and my job if I cannot succeed in feeling comfortable with publishing the book that often feels mentally contaminated. The relationship I hoped would last forever, the relationship I poured so much energy into, has ended. In my 20s, the damage was emotional. In my 30s, the damage is existential.
Exposure work is draining and therapists often recommend not only self-compassion, but also a system of rewards for doing the things that cause you so much terror. Before I drive back home, I stop at a restaurant and eat lunch. For the next three or four hours, I still suffer waves of revulsion based on what we did. So I do what everyone does when they need to feel a little less alone: I WhatsApp my friends.
Molly and I were in the same acting program in college; I met her when she appeared in a play I directed. She’s known me since before I came out and we have been friends for nearly twenty years. So she’s first on the list. “I hope this makes you laugh: today in ERP I was instructed to lick my hand and then run said hand down the banister and touch every magazine in the office. Which I did, with 100% acting student enthusiasm.” I include the emojis of “puke face” and “hair standing on end.”
“HAHAHAHAHAHAHAHAHAHA!!!!” Molly writes. “And also: I just want to give you all the non-triggering hugs in the world. That sounds soooooo hard.”
My friend Laura also nearly cackles: “HA! Just think of your memoir!”
Caroline, who has just had a baby and is thus textable most afternoons in between meltdowns and breastfeeding, writes wryly, “That falls in the category of weirdest homework assignments, I think.” But she also asks an important question: “Could you do it?”
“I did it,” I write. “And then I shook for five minutes.”
“Ugh, the shaking is not fun. But I’m proud of you!”
Even my ex is both amused and disgusted. “Omg!!! That’s so weird!!!” She punctuates her text with the “slurpy face” emoji.
I have the most amazing friends in the world. There’s some kind of urban legend that most people have eight close friends. Hardly any of my oldest friends live near me. But one day, when I’m trying to think through what community means, I make a list of all the people that I may not talk to on a daily basis, but who I know would come see me in an emergency or at least send somebody who could. It’s a lot of people. People in this world that I had the pleasure of meeting and sharing space with; people who are so compassionate and funny and creative and smart and tender. And who have no problem with talking about the weird things happening in their brains — or in mine. I am very lucky and incredibly grateful. Doing this alone would be miserable and terrifying. Doing it with understanding friends makes it just terrifying. My friend Gabi sends me a magnet after this: “Sometimes I wrestle with my demons,” it reads. “Sometimes we just snuggle.” I put it on my freezer, right above the OCD rating scale handout I’m supposed to use when charting the intensity of exposures.
At home, I grade papers and get ready to go back to work on Tuesday. I make it through the day, but when I lie down, I cry out of the relief that I will soon sleep. It’s difficult to contemplate having to do things like this all the time. When we were debriefing after exposures, my therapist insisted that I always have a choice during an exposure. But it is hard for me to contemplate what it means to embrace choosing. Right now I just feel trapped: either I keep doing compulsions and keep strengthening the affective hold OCD has on my life, or I force myself to go through with exposures that fill me with revulsion and pain.
What choice could I possibly have?
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Did you miss the first essay in this collection? Read “The Spiral” here.
The next essay in OCD Academy can be found here.
For all the essays in this collection, go to my profile.
