A steep learning curve.

Ex-Service User hasn't ritualized his anxiety, but he is obsessional and the obsessional thinking is certainly compulsive.

Now I'm asking myself, just what is it about a 'diagnosis' that makes me feel better? How do the words help?

First of all, the words.

At the top of this page I say my son was suffering from 'psychosis' in so much as the word translates directly to illness of the soul...I leave the word psychosis unchallenged. I think psychosis is one of those things that doesn't really need a text book description for you to recognize it in operation. You will know it when you see it. A psychotic person is in a different reality, animated (understatement!) struggling, dissociated - too far away from any shared versions of reality to reach, waving and drowning....

Apparently there are two main pathways to psychosis: depression and schizophrenia. The difference is, a psychosis growing out of depression doesn't take over the whole person, the depressed psychotic person can switch off the mad reality to talk to people with whom psychotic talk would cause trouble....This is something a schizophrenic person cannot do. For them, their altered reality is total.

And now we have OCD added to the mix. The presenting issue is an obsessive compulsive desire for self-recrimination based on the idea that he has committed unforgivable crimes in the past and 'seen things' he shouldn't have. Oh and so the CIA / the devil / MI5 or the American military are coming for him.

Yes...I do find myself saying to myself "I saw something nasty in the woodshed" under my breath each time we head into another bout of it.

From psychoanalysis we have 'denial' and 'avoidance' meaning there are terrible wounds in the soul that are causing the 'madness' As the sufferer isn't able to deal with the pain of the real wound he concocts a complicated 'cover' story about having a brain tumor, or of being the most awful person in the world and the emotional importance of this story feels true enough to the sufferer...but of course, it always misses the mark as he tells it. Telling the cover story can never bring resolution or healing. The rules of psychoanalysis state that a person deep into denial will heal, as he gently lets go of the self deception and begins to integrate the 'terrible' reality, discovering that it isn't a danger - for the past has gone and the awful thing has been survived, and acceptance and love are waiting on the other-side.

The element that is missing from psychiatry's depression and schizophrenia and from psychoanalysis's denial, is addiction. This is what makes OCD different perhaps?

My son's OCD scale recriminations feel to me as if they are a form of self-harming. In the same way as cutting oneself often starts as a way to externalise and try to get to grips with psychic pain, the cutting acts as a cover story, a form of denial. From I hurt because I have been hurt, cutting gives a new explanation for pain - and a rush of endorphins.

That rush of endorphins locks the behavior into repetition, and nothing will shift it until the person discovers for himself that the pain to gain the endorphin isn't worth it....that his whole life is on fire, that everything is being consumed, dragged into the nightmare scenario he is intent on building up to a catastrophic end.

That is how I see it...and the words help, how?
My observation leads me to see my son's OCD as an addictive behavior. The books and recommendations on how to treat explain how a sufferer reacts to a 'spike' in anxiety with a panicking attempt to shut down the anxiety, creating all sorts of emotive narratives to explain the feeling. The way out is to learn not to struggle, not to fight, just to allow the feelings 'to arise and pass away'. For it is the spiraling, increasingly horrific narrative that feeds the anxiety....

Our problem is, ex-Service User can't accept this explanation because it doesn't feel true.

The art is to re-frame this in a different way, in a way that fits his view of reality. Fortunately I'm more of a 'constructionist', with no real problems about using an existential view of reality...

So, on we go....