Exposé

once I was small and sure the sun would fall out of the sky

Last week, K and I were floating in the pool, bellies up and freshly shaved. We used to do this as children. When we were very little, we’d balance on the palm of my dad’s hand, and dive off into the water. In this pool, we are too big to stand on any hands, we’re 24 and 25 and K is telling me about the children she teaches, and when she speaks it’s like the sun is a spotlight and I rest my head on the pool deck, and feel the warmth radiate up and down. I could listen to her all day. K has known me longer than anyone except my parents. We met at age two, both only-children wracked with separate anxieties, escaping together into that private world of invention. We were co-conspirators; the time we spent together was finite and precious, sealed on each end by separation. We were not sisters oversaturated with each other, or cousins, or even really friends. That would come later. My plum-sized brain registered her as something like a mirror. I was always seeking patterns of similarity, of specificity and meaning. Identity was a permeable membrane, but K has always been herself, and I would recognize her anywhere. No one else has witnessed me like she has. She saw me panic, she saw me squirm. If you stripped away all the self I’ve spent years constructing, the affects I’ve adopted, the personality quirks I’ve absorbed from others and made my own, K would still recognize the slimy thing at my center.

In the pool, as adults, we were separate and whole. We were talking about her kids, and then all of a sudden we were talking about ourselves, those tiny things we used to be. We were talking about the therapy we did or didn’t receive. As kids, we were both anxious and over-attached to our mothers. I was afraid of the lead ink in newspapers. I undertook elaborate rituals to protect my parents — particularly my mother — from some amorphous harm that resided just out of sight. I was convinced I’d be poisoned by cleaning products, afraid to swallow in case the poison had somehow gotten into my mouth. Instead, I’d spit; onto the grass, or pavement, or into the front of my shirt. Teachers were concerned, they told my parents about the obsessions and the wet splotch. Other kids were confused and (understandably) put off by all this, but K was kind. She knew that fear. She had it too.

When I got diagnosed, I found it glamorous. It certainly didn’t help with my warped only-child understanding of the world; that everything that happened was because of or in spite of me, and that I had a responsibility to at least attempt to control it all. Having an explanation was a relief. I could finally point to something and say: there it is, that’s why.

bizarre and overly formal diary entry circa 2008

I have met many well-meaning strangers who assume I am addicted to washing my hands. That I’ll have a meltdown if my desk isn’t neatly arranged. I guess that’s what happens when you name something, you assign it an expectation. Some therapists even thought it was funny that I was so terrified of cleaning products, surprised they weren’t one of my closest allies. There was a twofold sense of deviancy; first, that the behavior itself was abnormal, and second, that somehow, it still wasn’t the right kind of abnormal. Growing up, I got the sense that the treatment for OCD — including the treatment I would go on to have — was responding to a very narrow set of behavioral precedents. Some of these included me, and some did not.

At age 8, I started meeting with Dr. L, who suggested Exposure Therapy, the process of gradually acclimating a person to a feared object, situation, or activity to increase tolerance. We started small, with Dr. L laying down a line of Comet, asking me to step over it or stick my toe in. I’d put my finger in a bottle cap of Windex, and a few minutes later, when I wasn’t dead, it seemed possible that I might be cured. I remember the gritty feeling of the Comet between my toes, the clean, sweet antiseptic smell. I’d sit in Dr. L’s office, a warm mahogany den with hibernating vertical blinds. She’d give me a piece of candy and tell me it was poisoned, and I’d pop it in my mouth. Butterscotch. I kept on thinking: she’s not taking this seriously. I felt that the source of my fear was being misidentified. She didn’t see it when the worry mutated, becoming increasingly improbable, and somehow truer because it was new. A new worry held power, a virus with no antibodies against it moving through me and swallowing all the cells. Too few fingers to count them with. Dr. L saying, we’re out of time for today.

For certain kinds of OCD, Exposure Therapy makes sense; for adults, with a specific understanding of the boundaries around a therapy session (when it stops and starts, when they can opt-out), or for worries that operate within a closed loop. You’re afraid you’ll get sick from touching a doorknob —> you touch the doorknob —> nothing happens —> the weight of the fear diminishes. Exposure Therapy fails when a fear is mutable, or when it is not physically reproducible, and thus impossible to disprove. What’s the exposure for what-if-I’m-a-pedophile OCD? Or what-if-my-subconscious-mind-is-planning-to-kill-my-family OCD? In this instance, the compulsion may be Thinking itself: anticipating a possibility and neutralizing it by drawing it to the forefront of awareness.

As my treatment progressed, we moved on to one of the bigger fears I had: that something would happen to my mom. I’d sit in Dr. L’s office and my mom would walk across the street to a butcher shop. While she’d walk through aisles of cold cuts, and refrigerated air smelling of salt and skin, I’d imagine all the ways she could die. That was the exposure; wearing myself out with terror until the fear became mundane. When I’d exhausted myself, Dr. L would let me use the phone to call and tell her to come back. I played along with the exposure — though I didn’t trust it — in order to reach that moment. My ear pressed against the receiver, body ahum, the answer click like cool water. I remember the tone of each digit of her phone number, the relief in that little seven-part song. After, they’d ask how it went. I never knew what to tell them, so I said it was good. That I felt stronger. I was exhausted and frustrated that they didn’t understand how this was pointless. The fear would keep evolving, and I knew that the next time the panic swelled up in my throat, it would be entirely new and specific. A grocery trip, a bomb threat to the university where she worked, the long walk to her parked car, a freak accident, something outside the realm of prediction. This worry would always be real and possible, and there was no exposure that would reveal it as a lie. How do you habituate a kid to the idea of her parent dying? My only power against this fear was imagining it. The worry and the exposure became the same thing.

Then I grew up, and as a side effect, things got better. I gained autonomy, and my thoughts adapted to a more textured world. It was exhausting to worry about certain things. Dr. L ended our treatment rather abruptly and moved out of state (nothing suspicious there). It took years (and medication) to get a handle on my OCD. Now my brain is quiet and foggy, and only occasionally brutal to me. For many years, I didn’t think about Exposure Therapy at all. I didn’t think about it as something harmful. It was just something that had happened to me.

It was in the pool with K listening, and me hearing my own words for the first time, that the absurdity emerged anew. I was telling her about my mom crossing the street to the butcher shop, me visualizing ad nauseum: a car flipping her through the air, a faulty light fixture, a flash flood, etc. I told her how my body would wear itself out from the terror. I’d reach a point of exhaustion, still afraid, but unable to imagine any further. Eager for the phone call to mark the ending. K said: I’m sorry. I wanted to brush the words off, but they lodged in my lung, a cough. Then I realized I’d never stopped the exposure. I’m doing it still. I’m far from home. I have a car and a lease and a job, but when panic sets in all I know is to wait for that phone call. Wait for someone bigger and braver to tell me it’s over. On those occasions when my brain is brutal, when a new worry wracks my immune system, my response still takes the shape of an exposure. I wear myself out, I get tired. Sometimes, I call my mom, thinking it’ll bring the same relief it used to. If she answers, she doesn’t tell me it’s over because she can’t. I feel like a rat conditioned to press a pedal. The worries are smaller and bigger and I keep trying to stop them the only way I know how.

K tells me I’m not alone, and I know it’s the truth. Wet and glistening in the pool, we are every age we’ve been when we’re together. When I ask her to describe our relationship, the word she chooses is primal. What does it mean to know each other that long? To have learned about terror, joy, the mechanics of being alive alongside her? Our earliest memories are blurry. We were shapes to each other before we were people. Sometimes, with K, I feel too visible. I worry that she looks at me and still sees an anxious little thing playing dress up. When I look closer I realize it’s that mirror between us playing tricks. The eyes watching are mine.

I’ve had lots of therapists since Dr. L. They’ve practiced ACT and CBT, they’ve told me proverbs, they’ve affirmed and resisted, they’ve embraced my diagnosis or called it into question. One of my therapists discouraged me from saying I had OCD, she said that the label itself might be something I’ve outgrown. In some ways I could understand this, looking back on my robotic diary entries, the charts and terminology through which I understood myself. When I was in school, I tied almost every paper I wrote to Looping Effects: the idea that by naming a behavior, and by extension a person, with a diagnosis, you alter and shape their behavior to fit within the parameters of that label. We adapt behaviors for a lot of reasons; to qualify for treatment, to be recognized in a biomedical framework, to be seen and to understand ourselves. I can relate to this, when I think back to what a diagnosis provided me as a child: an explanation for my own behavior, which was until then a mystery to me. But as much as it was an access point, the label was also a barrier. It left me isolated from my peers, made me feel alien and solipsistic. I was blind to how everyone around me was also abnormal and idiosyncratic, because that’s how children are. The abstract boundaries of certain worries stranded me outside the diagnosis, while others, discrete and familiar, granted me access to it. The label led me into the fold, into that office, towards all the consequences of an incompatible treatment.

This isn’t a research essay. This isn’t a measured accounting of the mental health treatment landscape in the US, or in Albuquerque, NM circa 2008, or an assessment of the efficacy of Exposure Therapy in children (although that exists, if you’re curious). This is an attempt. To put my treatment in context, to name and unname my terror. To throw the door open in that room, scoop my child self into my arms, and carry her out of there. To tell her that there are some worries you can’t shake, but that with time she’ll have a brain built to contain them. There is no phone call to tell her it’s over. It’s never over, and that’s just how it is. One day she’ll be sitting by a pool with K, and she and K will be old, and fierce, and heartbroken, and happy, and sometimes still really, really anxious. There will be a thing hovering there that she never got in that room. It will be relief. ☞