Author: Ben Sedley, PhD, PGDupClinPsyc
A cute little model train chugged around its miniature track, past toy people, houses, even a duck pond. In the middle of the train tracks was a green hill with tiny trees attached. But wait a minute, that’s not a hill – that’s a real human butt painted green. Suddenly the butt erupts as if it were a volcano, but I’m afraid to say the lava was made of poop that sprayed everywhere. Sorry, hope you weren’t eating while you were reading this paragraph. If you want to see this testament to human creativity, it’s an old Jackass clip called ‘Poocano’, you can find it on Youtube.
My client Jack, (Jack isn’t his real name, but he did give me permission to share his story) and I watched it together in therapy (well, almost together – at the moment therapy is all done via Zoom). For ten years Jack has struggled with contamination obsessive compulsive disorder (OCD), specifically a worry that he might have poo on him. Whenever he was out of the house he had strict rules and routines for himself to help him feel uncontaminated. He wouldn’t use a bathroom outside of his house, which meant that he had to avoid drinking liquids most of the day and couldn’t plan to do anything after work without going home first. He had rules about how to wash his hands, when to change his clothes, and how to keep his workspace clean. His life felt small and stressful. There was no room for spontaneity or discovery, no option to travel to new places or try new things.
Then coronavirus and the lockdown happened and he felt safe at home, no need to send himself out in a potentially dirty world. At home he could drink water when he wanted, wear what he wanted, use the bathroom when he wanted. However, Jack was miserable. All his years of hard work, pushing himself and challenging the OCD were undone. His OCD sat comfortably, feeling in charge of the situation.
Jack and I had our weekly Zoom sessions, trying to come up with ways that we could continue to do our exposure and response prevention (ERP) work during lockdown. Jack boldly suggested he watch poo videos on Youtube. Turns out there are a lot of these. The old MTV show Jackass particularly features many clips where Johnny Knoxville and his collaborators cover themselves or others in crap. The poocano was just one of many brown highlights.
Not only did Jack watch these videos, but he noticed something really important. For years, he thought the problem was being worried about having poo on him. But,as he sat in his clean home watching Jackass, he felt as gross as if he had gone out to places he thought of as contaminated, even though he knew there was no actual contamination.
He noticed that the problem wasn’t being around poo (which anyone would find gross and then go clean themselves), the problem was he didn’t like having the thought ‘there might be poo on me’. This meant that exposure to a video or just thinking about poo was as troubling for him as if he was out and about using public bathrooms. It meant that all his cleaning rituals weren’t reducing his distress because the problem wasn’t poo, it was a thought about poo (and you can’t clean a thought away).
This huge realisation allowed us to shift our therapy goal from increasing exposure to faecal matter to working towards a place of being able to tolerate uncertainty. To be able to say, “I know what my OCD is telling me, but I’m curious to see what else is out there.” And to take bold steps towards the life he cares about and to respond flexibly to whatever crap life throws at him.