Primary Obsessions. Charles Demers
“My family’s from northern India. There’s no savannah.” She appreciated the interruption; if he heckled, Sanjay kept Annick outside of the prepared script, the grooves worn into language by repetition. “Alright, you—we’re all from Africa originally.”
“Okay, okay, I’m sorry.”
“We’re on the savannah, and our minds and bodies know that we could be in danger, because of threats—panthers, tigers. Some kind of apex predator. Our minds and our bodies know that if there’s a lion in the area, we’re in big trouble. So for safety, for survival, we scan to ensure the absence of lions. But ironically, how do we establish that there are no lions?”
It took Sanjay a second to realize that the question wasn’t rhetorical. “Huh? I don’t know.”
“What do we look for, in order to establish that there are no lions?”
“Lions?”
“Exactly. We confirm absence by scanning for presence. So similarly, when we’re anxious, in present day, about a threat, we look for the threat. But when the threat is an intrusive thought, the only way to check for it is…”
“To think it?”
“You got it. So that’s the error of interpretation. Rather than realizing that the thought is just garbage, people with OCD worry that it means something about them. And to scan for the perceived danger that the thought represents, they keep having it.”
“That’s so fucked up,” he said, not looking up at her anymore but instead at the carpet, his head shaking gently, gobsmacked at the sheer, galactic unfairness of it all.
“And the worst irony is, the people who worry the most about the thoughts are the people who are the most repelled by their contents. So the person who is constantly distressed by blasphemous thoughts? They’re usually the most devout religious believer. And the people who have violent thoughts, they’re actually the least likely to commit an act of violence.”
“So you’re saying no matter how often I have this image, this thought of killing my mother, I’m not a killer.”
It was hard not to just give him what he wanted—to not reassure this young man who had first come to her after a May long weekend road trip, saying he’d nearly thrown himself off a trestle bridge in the Rockies to escape the murderous thoughts he couldn’t stop himself from having. The young man with eyes red from tears now sitting across from her, his hands laid across knees he didn’t even know were jackhammering.
“What do you think?” she asked instead.
“Please don’t say that.”
“No, really Sanjay. What do you think? Do you hate your mother?”
“I love her more than anything.”
“What does that tell you?”
“I don’t—I just need for you to tell me I’m not a killer.”
Annick closed her eyes gently and inhaled.
“Look, I know it’s not your job to—”
“It’s not that it’s not my job, Sanjay. It’s that giving you reassurance may make you feel better in the short term, like the rituals of hand washing and repeating her name, but in the long run it reinforces the importance of the thoughts. Just like the compulsions do.”
“But I’m not, right?” he asked again, his voice quavering just at the edges. “I just need to know that it’s okay for me to be around her.”
“Let me put it this way: If I thought you were a danger to your mother, or to yourself, or to anybody else, would I just let you go home at the end of the session?”
He chewed the inside of his cheek. “No, I guess not.”
“Oh, you guess not. I’m glad my professional ethics are so firmly established in your mind.”
He smiled.
“Alright, you—I’m going to see you next week. I want you to keep taking notes in your journal on the intensity and frequency of the thoughts. Let me know if there are any changes or shifts in the content, too.”
“Got it,” he said softly.
“Your hands look better than last time, the knuckles. So you’re resisting the urge to wash them repeatedly?”
Sanjay shrugged, his face pursed with bitterness. “My asshole roommate was complaining about me using the bathroom too much and going through the soap so quick. He got all puffed up like he does, right up in my face. I didn’t want to go through that with him again. It’s just not worth it. I felt like I had to stop.”
“Well, I don’t know… sounds like he’s doing you a favour. It’s like with prostates—sometimes the gateway to good health is an asshole.”
“Wow. Did you just come up with that?”
“Why do people find it so hard to believe that I’m spontaneously hilarious?”
“No, I didn’t mean—”
“Sanjay, I’m joking.”
“Anyway, I just—I know it’s probably not good to follow up or whatever, but it’s so hard. I’m just sitting there shaking, I just need to wash them. I feel like I’m going crazy if I don’t, you know, do the thing with my hands under the water that, like…” He trailed off.
“That what, Sanjay?”
Sanjay murmured now, with a shame that was all too familiar in Dr. Boudreau’s office: the shame of someone who knows something will sound crazy but has to say it anyway. “That cancels out the bad thoughts.”
Annick nodded understandingly, with a smile that strove to be both warm and formal.
“I understand, Sanjay. And listen, it is very normal for people with primary obsessions OCD to have those kinds of external compulsions, as you might see in, say, movies about OCD… checking the stove, washing hands. And then there’s the worst-case scenario, where the compulsions, and how they are or aren’t carried out, can themselves become evidence—‘I didn’t lock the door because deep down I really want my husband to be hurt,’ or ‘I didn’t wash my hands properly on purpose, because I want to hurt people.’ It’s a Chinese finger trap. You can’t get out of it by pulling harder, because it just makes it worse. The only way, I promise you, to lessen the frequency of the thoughts is to lessen their power and importance. And for that, you’re just going to have to sit with the anxiety you’re describing. Know that it can’t hurt you. That it can’t last forever. Eventually, it goes away.”
“Okay.”
“Things are still tough with the roommate, huh?”
Sanjay rolled his eyes, shrugged, nodded, shook his head.
“That’s quite the gamut of responses you just ran.”
He smiled crookedly. “My mom’s on me to move back in with her—I don’t know. I’m thinking about doing it.”
“Yeah?”
“Yeah. It’s just that her place is so far from school. And I don’t know—Jason’s a dick, but beggars can’t be choosers in this city, right? You find a room, you take it. The first time I met him I thought, you know—I mean the guy looks like a meathead. He is a meathead. But I don’t know, he had all these old Vancouver hardcore posters up around the living room, nice frames and everything. Shows from before we were born, old D.O.A. shows from the Smilin’ Buddha and stuff, and we talked about the Subhumans and the Modernettes. I thought, ‘See? Don’t judge a book by its cover!’ I don’t think we ever talked about music again. I move in and he just goes straight asshole. I don’t know. He’s a bouncer, so at least I have the suite to myself at night. But when he’s there…” Sanjay shook his head.
“No