(This article was originally written in Chinese. You may access it here)

You may know someone who is a clean freak. A little obsession with cleanliness may be harmless, but if it is serious, it may become a clinical problem, commonly known as obsessive-compulsive disorder (or OCD). OCD is a psychological disorder that manifests in excessive anxiety. It consists of two key components: obsessive thoughts and compulsive behaviors.

The first component, obsessive thoughts, usually makes people feel extremely anxious. Their constant ruminations typically revolve around some kind of threat or danger to their own lives or someone else’s (eg. worrying about dirty hands, unlocked doors, or knocking down people on the road while driving). Therefore, in order to reduce anxiety, patients would develop the second component, which is compulsive behaviors. They might consciously or unconsciously repeat some fixed actions or rituals (such as cleaning, counting, checking behaviors) until they feel more at ease. If these rituals are interrupted, disturbed or stopped, the patient will feel extremely distressed, and is likely to have to repeat the rituals from the beginning, resulting in spending a lot of time and energy on their compulsive behaviors. Therefore, many patients seek treatment because their work or family life is seriously affected. For example, they constantly wash their hands until their skin cracks and bleeds, or they are unable to hand in their homework or go to work on time. Often, family members also complain about the patients occupying the bathroom for too long; or they felt tortured and fed up with the patient’s persistent anxiety and constant demands for reassurance.

I had a client, Jane (not her real name) who came to see me with her mother. She is a 30-year-old woman, highly educated, unmarried, and living with her parents.

At first, Jane was very eager to tell me everything about her OCD symptoms. She said that whenever she passed by a railway station, or encountered anything related to it (including if she met people who had been to the railway station, or if she read about it in the media), she would feel very uncomfortable, like her body was “dirty” and she must wash herself from head to toe. Moreover, everything that she was wearing or had with her, including her mobile phone, had to be cleaned or at least wiped once. At times she had even gone to the extent of throwing away her clothes when she felt terribly anxious. Feeling helpless with her daughter’s behaviors, Jane’s mother brought her to see me. According to her mother, Jane refused to listen to her advice, but then would demand persistently for reassurance whenever she was anxious.

When I asked Jane about the time when her symptoms started, she tried to avoid by saying that she didn’t want to think about it. Her mother, who was very close to her and frequently spoke on Jane’s behalf, also appeared hesitant to mention anything that would trigger Jane’s anxiety. According to her mother, Jane’s symptoms probably began during her college days, when she took the commuter train to college every day. Jane was reluctant to say more at first, but gradually opened up and revealed that she used to be very happy taking the commuter train then, as a male friend would call and chat with her during the train rides.

According to Jane, the guy had said a lot of sweet words to her and even promising his commitment to her during those phone conversations. However, their relationship remained ambiguous in that way for a long time. Despite Jane’s multiple attempts to invite the guy to come to her house and meet her parents, or to meet with her in person, he would always find an excuse to decline. On the other hand, he continued to keep her hoping and waiting for him; sometimes he would even express his sexual fantasies for her and entice her to spend the night with him. Although Jane did not agree to his sexual advances, she found herself emotionally so involved with him that she started stalking him on social media. When he found out that she was tracking his life, including his relationships with his family and friends, he became very angry with her. As the tension grew in their relationship, the man started ghosting her by calling her less, and then finally, there was no more contact since about a year ago. Feeling duped, Jane was very annoyed with herself. She felt deeply hurt by the man, but had nowhere to ventilate her pain. As her mother watched on helplessly, all she could tell Jane was “don’t think so much”, “forget the past and move on”.

Slowly, I helped the mother and the daughter put their stories and experiences together to make sense of Jane’s presenting symptoms. At one point, when the mother talked about how devastated Jane was after the man led her on and then just dropped her like that, I spontaneously expressed my empathy by saying: “WHAT AN ASSHOLE!!” And the two of them burst into laughter! Suddenly, the mood in the room shifted from heavy to something lighter.

It turned out that I might have given them permission to voice out something that they both were not able to say to themselves or each other for all these years. The mother was afraid to hurt her daughter’s feelings, whereas Jane tried to reassure her family by acting as though nothing had happened and just kept going on with her work and life. Yet, her heart continued to hurt as she had indeed lost a significant relationship.

At this time, I began to help both the mother and daughter to talk with each other. Jane bravely told her mother that she needed more time to recover from her grief; and her mother’s way of trying to care for her (that is, telling her to stop thinking about the man) actually made her feel more guilty and ashamed of herself. On the other hand, Jane’s mother also bravely acknowledged that her anxiety may have become burdensome to Jane. Instead, she expressed trust in her daughter’s wisdom and ability to deal with her own emotions. When both mother and daughter could convey their suppressed feelings to each other, they became more relaxed and were no longer as concerned about all the OCD symptoms like before.

This was our first session together. At the end, I invited Jane and her mother to meet me again if they felt that the OCD symptoms had not improved. To date, they had not needed to see me, so I imagined that OCD is less of a problem for them now.

This case reminds me that the most unspeakable pain is often about wanting to express your honest thoughts and feelings to the person closest to you, and yet you are so afraid of losing this person’s love and acceptance. When the frustration and resentment are kept inside for too long, our emotional health is bound to suffer and manifest in different forms of mental disturbance.

Perhaps we can all ponder on this question:

In your most intimate relationship, would you rather know the worst truth, or hear the best lie?

Written and translated by: Dr. Ng Wai Sheng

Image by: Anh Phan (magdeleine.co)

Disclaimer: All stories presented in this article are based on, or inspired by actual events. In certain cases, incidents, characters and timelines have been changed for privacy and confidentiality purpose. Certain characters may be composites or archetypes, and are not intended to depict or allude to actual persons or families. Any resemblance to actual incidents, persons, places or events is entirely coincidental.