Some Comments on the article in The Times, Monday
September 28th 2015

“I just couldn’t stop thinking”
by Rose Bretécher.
She tells Lucy Cavendish what cured her.

The article begins with the statement: “Rose Bretécher at the age of 29, is the latest publishing sensation. She has just written a book called Pure about her own form of OCD.”

It ends with a quote by Bretécher: “No one wanted to publish my book, she says, “but now everyone wants to know about it, and although I feel rather exposed and vulnerable, I’m proud I have got the message out.”

Indeed she should be proud, it takes great courage to be so open and the book will undoubtedly help unknown numbers of people now and in the future. But the good that this article will do by drawing attention to the book, risks being undermined by the inevitable journalese.

Bretécher is quoted as saying “There’s hardly any research because who wants to admit to having this form of OCD?”

The naming of her illness is attributed to Bretécher “ … Pure O, as Bretécher has named her illness, is not a scientific label. It’s colloquial really, I guess,” she says. “But it is the Pure O part because of its obsessional nature.

Both of these assertions are wildly inaccurate. Research on this form of OCD has been ongoing for many years, as has the use of the term Pure O, which is not so named “because of its obsessional nature” but because it features no outward compulsive manifestations; as a quick check on the internet will easily demonstrate.

Moreover, a recently published novel, ‘They Couldn’t Have Known’ by Sanden Grevelle, telling the story of a young man struggling with Pure O in the 1950’s, describes how he found understanding of his bewildering condition from its description and advice given in the work of great writers stretching back to Ancient Greece.

Furthermore, the assertion in the heading that Bretécher has cured herself is contradicted by Bretécher throughout the article.

So why the ‘publishing sensation’ and two page spread in The Times. Surely not because it is a about a beautiful young woman (pictured posing in full colour) under a heading ““I just couldn’t stop thinking about sex”; as surely a poor old man reduced to living on the streets by his condition, of which there will be thousands amongst the homeless, would receive the same attention.

Sanden Grevelle

Dr Raj Persaud and Professor Paul Salkovskis answer your questions about OCD.

The person who has disturbing thoughts is helped to see that this happens because they are a sensitive and kind person who hates violence and suffering. The shared understanding is used to help the person to choose to change and this is the toughest part.

Finally it’s important to note that CBT is about helping the person to be true to themselves. For example people troubled by blasphemous thoughts are usually people with strong religious beliefs. We don’t try and stop people from being religious but instead help them to see how to make it work for them. Would (their deity ed) condemn them for having these thoughts or would he see them as being like any other worry, that is, the exact opposite of what you hope for.

Overall CBT is about helping people to see things differently and then act on this perspective. It’s about empowering people to break free from this horrible condition.

One of the key question is why it is that you find these thoughts so upsetting. For many people it’s because they feel that having the thoughts means that they are a wicked person, may be responsible for harm or even that the thought might come true because they thought it. Dealing with those ideas is the first step and then the loop tape can help you confirm that nothing happens even if you don’t ‘fix’ the thought. Also, you can learn that if you ignore the thought the anxiety goes away.

CBT and anti-depressant that act on serotonin, in that order of preference. A great book is “Obsessive-compulsive disorder: The Facts” (Third Edition) by Padmal de Silva and Jack Rachman (pub: Oxford University Press – ISBN 0198520824). Also a newthe self help book by David Veale from Robinson (“Overcoming OCD”).

OCD and in particular a variant described as ‘ruminative’ OCD. This involves a preoccupation with worry and a fear that a particular thought will arrive in his head and he is working away to stop them. Sufferers tend to be rather intellectual because they think a lot and take thoughts very seriously – perhaps too seriously. At the heart of this disorder is a conviction that thoughts have great meaning whereas the approach from CBT is called a meta-cognitive approach which is to take a step back and consider how helpful this general approach to thinking is.

The therapeutic approach is not to take thoughts so seriously and consider the benefit of just allowing thoughts to come into and out of ones head without attaching too much significance to their presence or absence. It is also important not to assume we have too much control over our thoughts and to accept that this means we cannot be held too responsible for the precise content and nature of our thoughts.

There is another link which is that in my clinical experience sufferers from OCD and in particular the form manifested by rumination – where they are upset that they could even have some ‘bad’ thoughts and try to stop having them – tend to be more likely to be religious or at least, more conscientious, than the average person. This I think is because if you take the moral life seriously you constantly worry more about whether you are doing the right thing or not (if only politicians were more like this!) from moment to moment.

If you worry about yourself then this means you are more vigilant to signs of impending moral degradation. You then think that the very having of a ‘bad’ thought means you are a bad person. The problem with this reasoning is that ‘thoughts’ do not have the same significance as actions. Surely I can have the idle thought, lets say, of robbing my local bank which comes and goes totally innocuously, and that has a completely different moral status to me donning a balaclava and actually holding up the bank with a double-barrelled shot gun. OCD sufferers tend to think the thought is the same as the action.

Sexual thoughts in themselves raise troubling emotions for OCD sufferers as they are overly concerned with morals and obsess about whether they are immoral or evil for having certain sexual thoughts.

It is vital patients make sure they are getting the right psychological therapy which should not involve a lot of talking or dwelling on the past, but instead focuses on the here and now and actions the patient must take to counteract their anxiety and which exposes them in a gradual way to their fears.

There is a very small inherited element. What is inherited is some vulnerability to developing an anxiety problem; about 10 per cent. However many people with OCD don’t have it in their family and most people with it in their family don’t develop OCD.

OCD can start very early but reaches a peak in late teens. Most people develop it in their adolescence or later.