Noonday Demon , Andrew Solomon describes how he was taken to hospital with a dislocated shoulder and how he was terrified that the pain would trigger a mental breakdown, as it had done before. He knew his mind, its weak spots and vulnerabilities, and he pleaded with the emergency room staff for the chance to talk to a psychiatrist, to head off the psychological impact that he believed would follow the physical trauma. They didnât understand. They told him to relax. They told him to picture he was on a warm beach and to imagine how it felt when he wiggled his toes in the sand. Solomonâs shoulder was fixed, but within days his depression returned with a vengeance.
When I first went for help with my intrusive thoughts of HIV, I was told to wiggle my toes in imaginary sand too. I had gone to a drop-in centre run by a mental health charity on the edge of the university campus, and they had made an appointment with a counsellor. This was outside the medical system and that was deliberate. I didnât want to see a psychiatrist because that was for crazy people. I didnât want to talk to a doctor, because I didnât want anything written down. Stories in the newspapers at the time warned that those who asked their doctors about HIV and requested tests were being denied health and life insurance.
The counselling was useless. * We performed relaxation exercises and I pulled imaginary golden thread from my nose. Neither stopped the intrusive thoughts. And we talked about my childhood, my parents and my relationship with them. Thatâs classic psychodynamic analysis â the technique developed by Freud. That didnât help me either, but then, despite the claims of Freud and those who followed him, there is zero evidence that psychodynamics works with OCD. In fact, it could probably make things worse.
In the mid-1960s, psychiatrists in London encountered a middle-aged woman with OCD who had been treated for ten years with Freudâs methods. The woman had become obsessed with blasphemous intrusive thoughts when she was a child that became increasingly sexual when she was a teenager, such as thoughts about sex with the Holy Ghost. She carried out repetitive acts to reduce the anxiety â she dressed and undressed time and again and walked up and down stairs. Taught by Freudian therapists about the importance of sexual symbolization, she then found it traumatic to close drawers, insert plugs, clean tall glasses, enter trains and eat bananas.
Much of Freudâs take on the causes and treatment of OCD now looks ridiculous, yet it dominated approaches to the disorder for decades after his death. Thatâs not because he was right, itâs because his sky-high profile ensured his work on obsession was translated into English, which became the most widely used language of the new field of psychiatry in the twentieth century. This translation process created a problem. Freud, who spoke German, used the term zwangsneurose (obsessional neurosis). The word zwang was translated as âobsessionâ in London, but âcompulsionâ in New York. Faced with confusion, scientists introduced the hybrid term âobsessive-compulsiveâ, a label subsequently given to millions of people, as a compromise.
The popularity of Freudâs suggestion that internal conflict generated obsession only started to wane in the 1960s, when a new breed of scientists muscled in on the field of OCD. They were called behavioural psychologists, or simply behaviourists. The behaviourists had their own firm belief. All behaviour was learned, even abnormal behaviour. And as such it could be unlearned. To treat obsession, they just needed to find the right trigger.
*Â Â Â *Â Â Â *
The use of behavioural psychology to treat OCD comes directly from the famous experiments of the Russian physiologist Ivan Pavlov, who reported how dogs learned to associate food with a bell rung to announce mealtimes, so much so
When I first went for help with my intrusive thoughts of HIV, I was told to wiggle my toes in imaginary sand too. I had gone to a drop-in centre run by a mental health charity on the edge of the university campus, and they had made an appointment with a counsellor. This was outside the medical system and that was deliberate. I didnât want to see a psychiatrist because that was for crazy people. I didnât want to talk to a doctor, because I didnât want anything written down. Stories in the newspapers at the time warned that those who asked their doctors about HIV and requested tests were being denied health and life insurance.
The counselling was useless. * We performed relaxation exercises and I pulled imaginary golden thread from my nose. Neither stopped the intrusive thoughts. And we talked about my childhood, my parents and my relationship with them. Thatâs classic psychodynamic analysis â the technique developed by Freud. That didnât help me either, but then, despite the claims of Freud and those who followed him, there is zero evidence that psychodynamics works with OCD. In fact, it could probably make things worse.
In the mid-1960s, psychiatrists in London encountered a middle-aged woman with OCD who had been treated for ten years with Freudâs methods. The woman had become obsessed with blasphemous intrusive thoughts when she was a child that became increasingly sexual when she was a teenager, such as thoughts about sex with the Holy Ghost. She carried out repetitive acts to reduce the anxiety â she dressed and undressed time and again and walked up and down stairs. Taught by Freudian therapists about the importance of sexual symbolization, she then found it traumatic to close drawers, insert plugs, clean tall glasses, enter trains and eat bananas.
Much of Freudâs take on the causes and treatment of OCD now looks ridiculous, yet it dominated approaches to the disorder for decades after his death. Thatâs not because he was right, itâs because his sky-high profile ensured his work on obsession was translated into English, which became the most widely used language of the new field of psychiatry in the twentieth century. This translation process created a problem. Freud, who spoke German, used the term zwangsneurose (obsessional neurosis). The word zwang was translated as âobsessionâ in London, but âcompulsionâ in New York. Faced with confusion, scientists introduced the hybrid term âobsessive-compulsiveâ, a label subsequently given to millions of people, as a compromise.
The popularity of Freudâs suggestion that internal conflict generated obsession only started to wane in the 1960s, when a new breed of scientists muscled in on the field of OCD. They were called behavioural psychologists, or simply behaviourists. The behaviourists had their own firm belief. All behaviour was learned, even abnormal behaviour. And as such it could be unlearned. To treat obsession, they just needed to find the right trigger.
*Â Â Â *Â Â Â *
The use of behavioural psychology to treat OCD comes directly from the famous experiments of the Russian physiologist Ivan Pavlov, who reported how dogs learned to associate food with a bell rung to announce mealtimes, so much so
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