Managing OCD: A Tale of Green SUDS

Scholastic Writing Contest 2021

National Silver Award

            How I love the slippery, smooth texture of liquid soap, the pale green sheen, the elastic feel of the back pressure on the palm of my hand as I push down on the pump. Right now even, I am murmuring, “Green soap! Green soap!” over and over as I grab my mother’s hand and wring it tightly, begging her, pleading, insisting on having it. I have autism, and, like many people with autism, obsessive compulsive disorder (OCD) is a big part of my life.

            So are sensory differences and a weird mixture of inertia and impulsivity. This particular OCD started with my mom buying a new kind of hand soap. It was a different brand, and I felt leery about it at first, but after experiencing the cool, fragrant, slippery wetness of it, I loved it! I gave myself a pump, then another pump, mmm. Clean, clear, soft, slippery sensation- I was hooked! Sensory pleasures quickly morph into obsessions for me. Before you know it, I was in the bathroom not just before meals but after and in between to experience my green soap.

            I also have inertia, difficulty initiating voluntary movement, another common problem to people with autism. Inertia makes us look a-motivational or oppositional, but that’s not it. Even when I really want to do something simple like get up out of my chair to bring my dishes to the sink, it can take me forever to rise up. The body just doesn’t listen to my purposeful upper brain. But if mom right now were to hold that bottle of green soap across the kitchen, I’d fly out of my chair to get it. Impulsivity goes hand-in-hand with compulsions. The lower brain, whether driven by sensory desires or OCD, connects just fine with the motor circuits.

            But alas, she has hidden it. Mom tells me that if I earn it, I can have it. This is a strategy we employ all the time. I have a name for it. I call it turning the “mad dogs” of my OCDs into “sled dogs,” meaning constructive motivation. I earn points doing chores or homework in order to earn a taste of, a time-limited opportunity to engage in, my compulsions.

“Mom, give me a point for each sentence I write. Fifty points, and I earn my green soap, ok?”

“Sweet, good idea. And if you then limit yourself to one pump, I’ll leave the soap by the sink; otherwise it goes back into hiding, deal?”

She brings over a coffee mug full of chopsticks, so I can keep track of my points. I take one out of the mug and place it on the table. “Green soap, green soap!” I murmur happily. That “happily” is in itself a coup. Before the deal, I had felt so driven by my OCD that my SUDS (subjective units of distress scale) level had felt like an eight out of ten. Now that I’m earning points toward my heart’s desire (or lower brain’s desire) and can see an end in sight, I’m down to a five.

            Hmm, Mom is forgetful. Just now she forgets to give a chopstick. “Green soap, green soap!” I cry. She smiles and says, “Oops! Excuse me, nearly forgot!” and hands me a chopstick. I love Mom, for taking my repetitive speech as a reminder, not an obsession. Nice to get the benefit of the doubt. But she’s also tricky. Sometimes we finish a whole paragraph before she remembers to give me a chopstick. But I know that’s good for the brain. The goal is distraction, not to reward the maladaptive OCD circuit. What fires together, wires together, so the more I do my compulsion, the stronger it gets. Most therapists therefore strive to extinguish their client’s OCD by eliminating performance of the compulsion. But that strategy doesn’t work for me. My mind is like a fertile field that grows compulsions like weeds. As soon as we extinguish one, other ones, sometimes worse than the original, pop up like daisies. Jesus says in Matt 12:43-45, “When an evil spirit leaves a person, it goes into the desert, seeking rest but finding none. Then it says, ‘I will return to the person I came from.’ So it returns and finds its former home empty, swept, and in order. Then the spirit finds seven other spirits more evil than itself, and they all enter the person and live there. And so that person is worse off than before.” I think Jesus must have known someone with severe OCD.

            So Mom and I evolved this other way of living with OCD, using them, harnessing their energy to get around my other nemesis, that of inertia. That’s fire fighting fire, perhaps, but it’s a dance we have been practicing for a long time, and it works for me.

            Mom is tricky in another way as well, but I see the catch. She said I could indulge in the coveted green soap, but that the bottle only stays out if I restrict myself to one squirt. She is trying to get me to train my inhibition “muscles” by getting me to compartmentalize or limit my OCD to one pump. If it were up to my lower brain, I’d keep pumping till “my soap runneth over,” but the hope is that practice and logical consequences will shape my pumping behavior into what it should look like. Knowing Mom, if that bottle disappeared, it could take a lot of work to earn it back. That’s why I call Mom my “bridler.” In Plato’s “Phaedrus,” the human psyche is likened to a charioteer. Reason is the driver, and the two powerful steeds are appetite, which craves material and sensory satisfaction, and aggression, which seeks self-assertion and power. For me, the upper brain with its rational and moral purposes and intentions is the charioteer. Impulsivity is one steed and OCD the other. Plato says that from youth, the charioteer must practice exerting control over the steeds. If he succeeds in mastering them, he can drive the team to heaven. If he fails, the steeds will drive him to the other place through greed or selfish egotism. I, the charioteer, know where I want to go, but my reins, or cortico-striatal pathways that connect the upper brain to the lower, are lax. That’s why I need an assistant, a bridler. I often tell my mom, limber as she is, to jump quicker on those horses and bridle them, as they tend to get away from me.

            But now look! I’ve finished my fifty sentences. Time now to dismount and feed the horses. Wish me luck with one pump. I just have to remember to hold onto the reins. My SUDS level is down to a one, and I want to keep it that way.