This is meant to be a brief essay.
When I think about how the acting out of compulsions actually happens, there is a striking feature about them: it is as if procedures that happen automatically in other people, are very present in the conscious mind of patients with OCD. When walking to a window that I want to see to be closed, I am thinking of very little else, if anything. I realise that I am walking, with that control measure in mind. Then I start to stare compulsively at the checkpoints, the stimuli, that I want to make sure of. In a highly ritualistic, rhythmical manner I go through the series of checks (four in my case), that must result in a positive outcome in my head, a kind of reward. I use my hand to press those grips on the sliding windows that already are in the ‘locked’ state. In my head I hear myself saying to me: they’re closed here, there, there and there. But that is not enough. I have to repeat this ritual over and over again. Minutes pass by. And then I feel a sense of relief: I begin to realise that they are indeed closed. As I said, it all happens in a very conscious fashion. It is as if I had to make an elaborate mnemonic construct in my mind, something that I would be able to retrieve an hour or so later, when I would be at university, for instance.
When I asked others, later on in life, when I could deal a bit better with the symptoms, about their way of checking, they mostly replied: well, it’s a routine with me. I do it automatically, almost unconscious, I think. Can’t really remember having done it, but still am sure I did.
That is an essential difference between healthy people and OCD patients. Perhaps you see how enormously taxing, and time- and energy-consuming OCD can be: the checking of the windows is just one small part of a much larger total ritual, in which the whole house or apartment must be dealt with. You get tired and sometimes sweaty from all the intense staring and checking.
And as I mentioned in an earlier post: once I am out of the house, and am cycling to town, this burden seems to have all but gone away. My motor programs go smooth, e.g. the pressing of my feet on the pedals, the handling of the steer, indicating with my arm where I want to take a turn… in fact, cycling would be impossible if I would have to apply the same scrupulous checking that I did in my apartment. Same with looking, and perception: I just have to take a split-second glimpse to see whether a traffic light is green or red. Don’t have to check again. If I would have to do that, I would never ever get past a single traffic light.
The upshot is: OCD in this story is tightly linked to territorial feelings, and fears related to these (fear of fire, fear of burglary, fear of a water flood, and so on).
We will explore this interesting phenomenon, and the contradictions inherent in it, later in more detail. This chapter is mainly about compulsions in the checking sense. But for obsessions, a similar difference exists between patients and healthy people. There has been done quite a lot of successful research into which brain areas are involved, and how some specialized nerve cell loops play their part. The interface between regions that are very old in an evolutionary sense, and much younger regions is of importance. They are called basal ganglia, orbitofrontal cortex, anterior cingulate cortex, and prefrontal cortex, for instance. So: stay tuned!