I can’t die, my fingers are crossed!

If you want to understand what goes on in the mind of a person suffering from obsessive-compulsive disorder – to a certain extent anyway – you need look no further than the little superstitious rituals we all perform: don’t step on a crack, touch wood, cross your fingers.

Anxiety is what we feel at the thought of something bad happening. We may each fear different things (dentists, airplanes, public speaking, death, etc) but we all react the same way when we get scared. We do whatever it takes to get out of danger or reduce the threat.

This is easy to see when we fear things like getting run over by a bus (we run out of its way), but what are our options when we think of bad things happening in the future? Most of us will try to control possible outcomes. Unfortunately this control is far from absolute. If I am afraid of dying, I can try to adopt a healthy lifestyle but I am far from guaranteed it will make a difference.

Ultimately we have to face the fact that bad things can happen no matter what we do. But because we have such a strong survival instinct, we often do things simply to give us the impression of having control. This is where superstitions come in. In today’s Métro column, I tell the story of a woman suffering from OCD and a little ritual she had before bed. I was her way of “guaranteeing” nothing bad would happen.

In cases of OCD, the desire to control outcomes can end up controlling the individual. The more we give in to fear, the stronger it becomes. This is why one aspect of treatment for this and other anxiety disorders is to resist the temptation to act on the anxiety. Phobics must not avoid their fears (e.g., must eventually take that elevator despite having anxiety push them to take the stairs) and obsessives must resist the temptation to respond (e.g., hypochondriacs must resist checking the internet or their pulses, and germ phobics must not wash hands after touching an object).

For more on superstitious thinking, see I think I jinxed my rabbit’s foot.

See you in the morning!
(Source: À demain matin. Journal Métro, April 24, 2012). S.V.P. voir plus bas pour version Française.

I once treated a woman who had many obsessions. One interesting one was to say, “See you in the morning,” to her daughter before bed. Her daughter would say back, “See you in the morning, Mom.” Even when she was out late and got home after her daughter was asleep, she would always make sure to wake her and whisper, “See you in the morning,” until she heard back, “See you in the morning, Mom.”

Why did she do this? Well, she was terrified of dying. She also believed in a benevolent God and she figured that such a god would never punish a little girl who expected to see her mother in the morning. This was the woman’s way of ensuring that she would not die overnight!

Sure enough, it worked! Or at least it appeared to. But of course her survival was probably due to normal chance rather than any extraordinary protective power of a spoken phrase.

This case illustrates a simple reality about human beings: We want to live in a safe world where bad things can’t happen and we will do whatever it takes to ensure this.

Protection from threat
Any real or imagined threat will create anxiety. In order to reduce this anxiety, we will act to control dangers by running away or defending ourselves in some way. The problem is that we can’t control all threats – accidents happen, people die unexpectedly, tornados strike. In such circumstances, we will do something that makes us believe we will be safe. This is where knocking on wood or crossing fingers comes from.

Lack of absolute control: our biggest challenge
The desire to make absolutely sure nothing bad happens has some profound implications. In fact, problems of control are at the heart of most anxiety disorders, depressions, and interpersonal problems.

We all like to have control over our lives. This is normal and necessary since it serves to protect and guide us. Unfortunately we cannot have perfect control. No matter what we do, the possibility of bad things happening will remain. Health can be improved and love can be nurtured but neither can be guaranteed. However this isn’t all that bad. We in fact have a lot of control over our lives, just not as much as we would like.

If we focus on controlling what we can, we will be less enslaved by the things we can’t.

Voici la version Française:

À demain matin!

J’ai déjà traité une femme qui souffrait de multiples obsessions. L’une des plus intéressantes consistait à dire : « À demain matin », à sa fille, à l’heure du coucher. Sa fille lui répondait : « À demain matin, Maman. » Même lorsqu’elle sortait tard le soir et rentrait une fois que sa fille dormait, elle réveillait celle-ci et lui murmurait : « À demain matin », pour entendre : « À demain matin, Maman. »

Pourquoi faisait-elle cela? Parce qu’elle avait peur de mourir. Elle croyait en un Dieu bienveillant qui ne punirait jamais une petite fille s’attendant à voir sa mère au réveil. C’était la façon qu’elle avait choisie pour s’assurer de ne pas mourir pendant la nuit

Et cela marchait! Ou du moins, c’est ce qui semblait. Mais sa survie est sans doute davantage attribuable aux lois des probabilités qu’au pouvoir protecteur d’une formule magique.

Ce cas illustre une simple réalité à propos des humains : nous voulons vivre dans un monde sûr, exempt de malheurs, et nous ferons tout ce qu’il faut pour y parvenir.

Protection contre les menaces
Toute menace, réelle ou imaginaire, crée de l’anxiété. Afin d’abaisser ce niveau d’anxiété, nous contrôlons les dangers en les fuyant ou en nous défendant contre eux. Mais nous ne pouvons pas contrôler toutes les menaces : les accidents se produisent, les gens meurent, les tornades frappent. En pareils cas, nous ferons quelque chose pour nous faire croire que nous sommes en sécurité. C’est là qu’entrent en jeu les « touchons du bois » et « croisons les doigts » !

Le manque de contrôle absolu : notre plus grand défi
Le désir d’être absolument sûr que rien de négatif n’arrivera comporte de profondes implications. En fait, les problèmes liés au contrôle sont au cœur de la plupart des troubles anxieux, dépressions et problèmes interpersonnels.

Nous aimons tous avoir le contrôle sur nos vies. C’est normal et nécessaire pour nous protéger et nous guider. Malheureusement, nous ne pouvons pas exercer un contrôle parfait. Il existe toujours une possibilité que des événements négatifs surviennent. La santé peut être améliorée, l’amour peut être cultivé, mais ni l’un, ni l’autre n’est garanti. En fait, nous avons beaucoup de contrôle sur nos vies, mais pas autant que nous le voudrions.

Si nous nous efforçons de contrôler ce qui nous est possible, nous serons moins esclaves des choses qui échappent à notre contrôle.

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Posted in Anxiety.

Posted on 24 Apr 2012

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2 comments to I can’t die, my fingers are crossed!

  1. Heidi
    On Apr 26th 2012 at 00:23

    Hello Dr. camillo, I am having a lot of guilt at having to put my mom in a LTR. She has short term memory loss. She was living with us …hubby and 2 teenage boys,for 2 yrs after my dad passed away.She fell and broke her hip,and at this point we decided to place her.Every visit is so heart breacking….she wants to come home with me…but this is impossible….How do I deal with this guilt…She was such a good mom….

    • Camillo Zacchia
      On Apr 26th 2012 at 15:26

      I don’t envy your situation. Sometimes we are left with no options. It is always best when the person who has lost autonomy recognises that placement is the only realistic choice but this can’t always be the case.
      You wrote that she was such a good Mom. Well you also seem like a good daughter (especially having taken her in when she needed it). What really matters is that you have a strong loving relationship. In such a relationship, we don’t always have to agree, we just have to trust that we have the other person’s welfare at heart. And in this case, you clearly do.
      I’m sorry your mother doesn’t see it yet but just continue to be there for her and she will benefit from the love she nurtured. She will always remain connected to you and I am sure she will adapt to her new circumstances.
      Good luck.