Acceptance and OCD
By Fred Penzel, Ph.D.
Those of you reading this article probably think a lot about "change." That is, changing your compulsive behaviors, changing your obsessive thinking, changing the way you live, etc. Change is a fact of life. We all are in some state of change at any given time, whether we realize it or not. In many treatments for OCD, there is also a constant emphasis upon change. With all this changing or thoughts about changing going on, it would be very easy to overlook something equally important and without which change would not and could not happen. This is something called acceptance.
Acceptance means agreeing to something, believing in it, and viewing it as true or real. Accepting something doesnt mean liking it or grudgingly giving in to it. There are many things whose existence we accept that we do not like. OCD is a good example. There are many out there who suffer with the disorder who simply cannot acknowledge or accept that they have it, or that it is really having a very negative impact on their lives. Typically, when it comes to their disorder, these people do not change very much. If they finally do go for therapy, they cannot seem to bring themselves to follow through with treatment. The psychoanalyst Carl Jung once said, "We cannot change anything unless we accept it."
Much of what you need to know about acceptance and change (and therapy in general) is summed up in the Serenity Prayer (familiar to those who go to AA meetings): God grant me the serenity to Accept the things I cannot change, The courage to change the things I can, And the wisdom to know the difference.
I sometimes think that the mental-health field has become obsessed with the idea of change. This would be fine if we caregivers could change everything about the disorders of the people who come to see us for help. Actually, there is a whole list of things we cannot change or help you change. For instance, we cannot presently change the following facts:
- You have OCD.
- OCD is chronic - it wont simply go away on its own..
- You will have unpleasant obsessive thoughts and will sometimes respond to them using misguided compulsive solutions..
- Others will have a right to live free of your symptoms, and do not have to participate in, or cooperate with them..
- No one can "make" you better. You have to learn to help yourself with informed guidance..
- You will never "perfect" your symptoms, that is, getting all your compulsions "just right," and still being able to live like everyone else..
- As part of your illness, you may have problems figuring out how risky certain things are or how responsible you are for others..
- You had no choice in having OCD. It is neither fair nor unfair, it just happens to people according to the laws of chance..
- Getting well takes time and patience, and is hard work..
- In order to confront your disorder, you will experience anxiety and discomfort at times..
- Progress toward recovery doesnt always go smoothly..
- Being in recovery doesnt mean you will forever be 100 percent symptom-free. Once in recovery, you will continue to work on your OCD each day, although not as intensively as time goes on..
- You can slip sometimes and still keep your recovery..
- You may have lost some previous part of your life to the disorder and may not be able to get it back..
When you dont accept any or all of the above, what generally follows is some type of emotional disturbance such as anger, anxiety or depression. My own observation is that these disturbances then lead to bringing about the opposite of what you really want – you create a paradox. Some good examples of the kinds of paradoxes people create are seen among people who:
- are so angry and upset simply about having OCD that the stress they create makes their symptoms worse;
- want to get well through a quick fix without having to confront their symptoms, or feel anxious and so dont improve and end up feeling even more discomfort;
- want those close to them to help them feel less anxious by cooperating with compulsions, which ends up driving these people away, makes them upset and angry and causes them to withhold their support for the sufferer;
- unrealistically expect that in recovery they will never have a lapse or symptom flare-up, and when they do, get so depressed and angry at themselves that they have an even worse setback; and
- are so upset about having lost part of their lives to OCD, and they lose even more time due to the depressed and angry mood they create within themselves.
In actuality, change and acceptance are not exclusive of each other. They are linked together. Acceptance can actually be one of the most effective ways of bringing about change. The biggest problems within OCD are the sufferers misguided and illogical strategies for coping with obsessive thoughts -- what we refer to as compulsions. Compulsions can only provide short-term relief from anxiety. Over time, and through habit, they become the problem itself. Becoming a more accepting person would include letting go of the unwinnable struggle to control obsessions via compulsions, and turning to more effective solutions, such as behavior therapy and medication.
So how does one become more accepting? One way of achieving acceptance is to truly understand that many things in life cannot always be exactly the way we want. They may only be the way they are. We human being are very wishful creatures, and while there is nothing wrong with wanting things to be different, we are not in the Godlike position of being able to demand that things be as we say they must be. Resisting such demands is especially difficult for those with OCD, as they often have difficulty in the way they try to over-control themselves, people, and things in their lives. Remember that acceptance doesnt mean liking something, but just seeing it as what is real.
Another path to acceptance would be through living in the present. By this I mean not looking backward toward the past. Some insist that things shouldnt have happened the way they did. Other OCD sufferers often sit and continually obsess about past events, agonizing about what might or might not have happened, and whether or not they were responsible. You cannot change the past.
The other side of this is not living in the future. People with OCD tend to use the phrase "what if" a lot. They anxiously waste time trying to predict or control future events to prevent harm from coming to themselves or others. This, of course, is fruitless, as obviously no one can predict the future or prepare for every possible outcome.
All you can reasonably expect to do is to concentrate upon living in the present and do the best you can to fully involve yourself in whatever you need to accomplish at any given moment. The idea is to achieve a focus that enables you to let go of all other considerations and direct all your mental and physical energies toward your goal. If you dont think you can do this, consider that when you were wrestling with your symptoms at their worst and trying to control the uncontrollable, you were already doing this, but in a negative rather than a positive way.
Finally, it is vital to have an understanding of just what it is you need to specifically accept. I propose the following list, which I call "The Five Acceptances."
- Unconditional Self-Acceptance Seeing yourself as an acceptable, ordinary mistake-making human being who cannot be rated as a whole on the basis of a few selected characteristics or symptoms.
- Unconditional Acceptance of Others Seeing them as ordinary imperfect beings also, and understanding that they dont have to do as you say, or support your efforts if they do not choose to.
- Accepting Your Illness and its Nature Understanding that your symptoms are what they are; that they are chronic; that it isnt "unfair" that you have them; that as a result of them you may have poor judgment when it comes to risk and responsibility; and that they can be recovered from even if there is presently no cure.
- Accepting the Nature of the Task of Therapy Knowing that you are responsible for your own recovery; that therapy is hard work, takes time, and may involve discomfort; and that obsessions must be confronted and compulsions resisted.
- Accepting the Nature of the Task of Ongoing Recovery Learning that recovery is an active work-in-progress and something that must be practiced each day; that there may be lapses along the way; that you may have to take out time to grieve for what your illness has cost you; and that recovering means that you are now free to live in the same imperfect world facing the same problems as everyone else.
What I have outlined here may seem like a tall order, but it is achievable. Just talk with someone who has made a good recovery and you will see that they may have done most of these things without even being aware that they have names or descriptions. If you are working on the acceptance of change portion of your recovery, keep in mind the need to stubbornly refuse to quit. As the famous 18th century OCD and Tourettes sufferer Samuel Johnson said, "Great works are performed not by strength, but perseverance."
Fred Penzel, Ph.D. is a licensed psychologist who has specialized in the treatment of OCD and related disorders since 1982. He is the executive director of Western Suffolk Psychological Services in Huntington, Long Island, New York, a private treatment group specializing in OCD and O-C related problems, and is a founding member of the OCF Science Advisory Board. He can be reached at firstname.lastname@example.org or through the phone number on his website. Dr. Penzel is the author of "Obsessive-Compulsive Disorders: A Complete Guide To Getting Well And Staying Well," a self-help book covering OCD and other O-C spectrum disorders.