CW: Mental Health, OCD, suicide, mention of sexual violence
OCD Awareness month has always…
No, I got that wrong. OCD Awareness Month has always…
Start again. To me, OCD Awareness Month…
Maybe I thought something misogynistic while typing that. Am I sure I’m not subconsciously promoting bigotry? Is it contaminated? Am I irredeemable?
The idea of OCD Awareness…
No. Again. And again. This time it’s got to be right! Or maybe this time. Promise.
Given that this is just a snapshot of my daily thought processes, it may be easy to see why the concept of OCD (Obsessive Compulsive Disorder) awareness has always been quite amusing to me. Every year, autumn rolls around and I find myself repeating the same refrain: I wonder what it must be like to not be constantly aware of Obsessive Compulsive Disorder. And I’m even more fascinated, year on year, by the discourses that ‘OCD awareness’ tends to bring about; the information which seeps through the cracks of medical and psychiatric circles, or OCD support groups. Many of us have seen the most egregious cases. The absurd stereotypes, the quirky side character who organises their Sharpies by hex code and verges on homicidal when somebody hangs up a crooked painting. And thus the current culture of mental health awareness, particularly in the realm of infographics and Instagram posts, is hellbent on protesting these strange parodies. ‘OCD isn’t just washing your hands!’ comes the evergreen cliché. But OCD awareness sometimes seems to inexplicably stop at this vague refutation.
Rather depressingly, the concept that OCD is more than just cleaning and organisation is, for many, still a revelation. It is also, undeniably, still important. It certainly would have been useful for my nine-year-old self who spent days convinced that I’d caught rabies, or the newly 13-year-old me who was terrified that I was a sexual predator for reading fanfiction. OCD can, generally, be split into subtypes: some obsessions can involve cleaning and the fear of contamination; some can be distressing, unwanted sexual thoughts (or any other form of intrusive thought, be it religious, moral, or violent); some can be an obsessive need to check light switches, stoves, door locks. However, there is a common misconception that these obsessions, especially those of a more taboo nature, are representative of the sufferer’s genuine desires, or that, more generally, anybody with OCD enjoys any part of the disorder. This is all too prevalent, as a 2023 study on stigma surrounding OCD demonstrates: participants, when shown examples of intrusive thoughts (including those of a sexual variety), perceived the hypothetical OCD patient as a genuine danger. Stigmatisation of the less visible subtypes of OCD is rife, and many people still fail to comprehend the extent to which obsessions for many sufferers can latch onto the most absurd, extreme themes. Even the most taboo, knee-jerk example that you can think of, that springs to mind with an incredulous ‘surely not that, surely that’s too far’, can be, and inevitably has been, the source of some sufferers’ obsessions.
Even as much as it still proves necessary to break through the baseline stereotypes about the disorder, I believe that a great deal of OCD representation, which starts and ends with ‘it’s more than just contamination’, is woefully lacking in one crucial thing: in-depth knowledge of the overarching experience. OCD UK refers to OCD as a ‘serious anxiety-related condition’. But there’s something perhaps even more fundamental than anxiety characterising the disorder, which may be necessary to perhaps shape a more nuanced framework for OCD awareness. OCD is, as I experience it, primarily a shame disorder.
Regardless of subtype, regardless of theme, and regardless of the particular manifestation of the compulsion, the common thread for me is shame. It was shame at the content of my intrusive thoughts that almost drove me to attempt suicide when I was 16. It is shame now at the obsession of somehow contaminating my shared flat kitchen with bacteria or mould or bodily fluids that leads me to wash my hands sometimes upwards of ten times in a single cooking session. It is shame at the thought of dealing with these seemingly uniquely humiliating and isolating experiences that makes me so good at lying and minimising and hiding them from the people who care about me. And, above all, there’s a deep, inarticulate shame as I experience all of this in an environment as prestigious and successful as Oxford. I find this shame to be a near-perpetual experience, and it extends from the most taboo form of OCD to the most stereotypical. And yet the shame is the same. Even though it is by no means incredibly rare, with an estimated 1.2% of the UK population suffering from OCD, the disorder manifests in the unshakeable notion that these obsession-compulsion cycles are absolute, that I’m somehow intrinsically more dirty or perverse than the average Oxford student. Which may, counterintuitively, be a rather egotistical viewpoint. Such is the hypocritical shame of OCD that I, and many others, may experience.
This overarching shame then provokes an insidious long-term thought distortion. Like the frog in the pan who doesn’t feel the water heating up until it’s boiling alive, each step of the escalation is miniscule. Each of my new compulsions are a seemingly logical continuation of the previous one, in such a subtle manner that I suddenly realise that I have somehow ended up hosing myself down with antibacterial cleaner every day, or that I wholeheartedly believe in my false memories (a type of thought distortion where your memories of real events can become exaggerated or even entirely changed for the worse). And at this point, for me the shame becomes a double-edged sword: I simultaneously justify the often life-impacting compulsions with the shame that provokes them, and I feel acutely aware of how they could be misperceived as embarrassingly irrational. Reaching out for help is seemingly impossible because the obsessions feel somehow both legitimate (and thus necessary) and ridiculous. The pattern of normalisation of increasingly extreme obsession-compulsion cycles is, again, notably absent from much of the common understanding of OCD.
What is the point then of this shame-based framework of OCD? Certainly not just to wallow in my sense of self-pity, as the disorder for me can very often lead to some very dark places of anger and self-loathing at the sheer unfairness of the cards that I’ve been dealt. In many ways, the cards aren’t even always a terrible hand. If nothing else, this obsessive, intrinsically irrational disorder has left me with a great work ethic and the ability to take very little about myself seriously, albeit at the cost of years of my life. Instead, the emphasis on shame as a common experiential theme of OCD serves to reframe the overall experience beyond a simple set of subdivisions into neat categories. The shame of contamination OCD grows from the same root as moral scrupulosity OCD (a form of OCD involving obsession over your own perceived morality), and even though the former receives the brunt of the visibility (and therefore the stereotyping), the underlying experience is absent from contemporary OCD awareness discourses across both.
There isn’t necessarily a straightforward solution to this. The answer to the stigmatisation of intrusive thoughts isn’t for all neurotypical people to become pseudo-therapist-confessors (in fact, confession is often a compulsion of OCD in itself, so often doesn’t help with OCD recovery, as tempting as it often is). Equally, in my opinion a solution to the question of shame as an underlying feature of OCD isn’t an eternal pity party. For me, some of the best support I have received during an OCD breakdown has been a loved one more directly telling me to stop acting on my compulsive reassurance-seeking in the moment. My experience here may well not be a universal one; the shame framework conceptualises my struggle, but it is equally rash to propose it as applicable to all sufferers of OCD. Instead, we need to start by more generally broadening the discourse. No form of OCD is the baseline for comparison and no form is inherently worse or more multifaceted than another. Understanding that OCD awareness involves not the dismissal of one form of the disorder as a baseless stereotype but instead a universally wider understanding of the overall experience is the first step. Ultimately, there’s a long way to go for true societal acceptance of any stigmatised neurodivergence, and only so much nuance can be conveyed in a nominal awareness week, but it’s a start. And the freedom to share my experience with relatively little fear of the stigma associated with revealing my obsessions is appreciated by at least one woebegone sufferer.
If you suffer from OCD or OCD symptoms, or you know anyone who does, some good sources of support for OCD can be found below.