I’m talking on the phone with my little sister and she’s telling me how next year she’s afraid she might go crazy. She’ll be leaving for college in the fall, and she’s afraid that the Worry Boss might come back. “No,” I tell her, “That dude’s long gone, you’re going to be fine.” But I can understand why Kristen is worried, why we’re all a little worried; we’re worried because things are different with my sister. “You’re so strong,” I say into my phone, “You’ve worked so hard and come so far.” Kristen and I both understand that going to college will be a really big step, a step that at one point my parents worried she wouldn’t be able to make at all. As we’re talking, I think back ten years to when Kristen was eight years old, and would spend most of her time not on a playground but on a couch in a big building across town where she’d tell a woman named Jenny about the worries, the fears, and the obsessions that dictated her life. But now she’s eighteen, and she’s come so far. Far enough to sit at our kitchen table and tell her story, a story she keeps a secret from even her closest friends, to someone she’d just meant who needed more than anything to hear it – but that part comes later.
The dinner sitting on our kitchen table is growing cold as we wait for Kristen to go to the bathroom. The door opens, it closes, it opens, it closes, four times. “You’re crazy,” I yell from the table, “Just go to the bathroom!” Kristen has to pee, but the voices in her head are getting in the way. My sister is eight years old, and she can’t go to the bathroom, she can’t sleep, she can’t put her socks on, and she can’t close doors. As we go upstairs to get ready for bed, I hear the sounds of the bathroom door opening and slamming, opening and slamming, four times. I see her sniffing her toothbrush before she touches it. I see her sniffing it one more time. In retrospect, I should have blamed the Worry Boss that night at dinner, but I didn’t understand it fully then. Kristen opens her bedroom door and slams it, open slam, open slam, open slam, four times. I don’t have to watch her to know that upon entering her room she will check the crack between the bed and the wall eight times and sniff her sheets before she climbs into them to not fall asleep. We don’t have to watch her to know that she is far from fine.
“Our daughter is not fine,” my parents say to the doctor’s office who will conduct tests and mediate talks and talk some more and finally give us the diagnosis that my sister suffers from Obsessive Compulsive Disorder and severe anxiety: medication and Cognitive Behavioral Therapy recommended. “Yes,” my parents say, “Let’s get started now.” But in a couple of days, my sister is crying at our kitchen table because the Celexa that the doctor prescribed is making her hallucinate. “It’s going to be okay,” says my mother. “Kristen, I understand this is scary. Kristen, I’m calling the doctor, and we’re going to fix this,” she says over the crying. But she knows like the rest of us that it is not that easy. We all know it, and we’re all going crazy because of it. The Worry Boss is the name that my sister’s therapist Jenny gave to the voice in Kristen’s head that mandates the obsessions, the fears, and the constant worrying that things simply are not right. Jenny says medications are an integral part of the therapy; it’s just sometimes hard to figure out which medication fits. Because the truth is that when you are trying to combat mental illness and using medications that alter the chemicals in the brain, especially in brains that are little, that are only eight years old, that still have so much growing to do, things are not easy.
The year Kristen turned eight years old my mother drove her across the river several times a week after school to sit on a couch and face her fears. It was all part of the Cognitive Behavioral Therapy – a process that hopefully would result in Kristen being all better, being able to sleep at night, being just fine. To explain it in the simplest way possible, Cognitive Behavioral Therapy teaches you how to say “no” to the Worry Boss. Every session, Kristen faced her obsessions directly. She would describe them, reason them out, and explain the compulsion that would alleviate them to Jenny. And Jenny was teaching her how to fight it, how to say no, how to resist her own mind. It was a slow process, like building a kitchen table out of toothpicks. But again, nothing in the realm of mental illness is simple or easily fixed. We’d be crazy to hope that it would be. And for Kristen, it was hard. “I don’t know how she got the spider, but one time Jenny came in with a spider on her arm and just played with it there on her arm and made me watch,” Kristen tells me, “It was torture. But the worst was when she made me go into this tiny bathroom, shut the door, it was a big door, and lock the door and stand in there for a whole minute.” She pauses before adding, “People who don’t have it just can’t understand.”
This is what we understand of how OCD works. A person who has OCD gets fixated on certain thoughts, fears, or obsessions. It is almost impossible to break free from the obsession, and it consumes the mind completely blanketing all rational thought. Compulsions can alleviate the obsessions. This is what we saw Kristen often doing even before she turned eight years old. Opening and slamming the door to neutralize her fear of being locked in a room, the sniffing of every object in front of her to see if it was safe, the counting to make things even, the praying again and again to keep everybody she loved alive: the agonizingly long, tortuous, and crazy rituals were all compulsions that aimed to silence her obsessions, even if only for a second. Following the compulsions is a temporary solution, like itching a mosquito bite, but as Kristen tells me, for a moment, just a brief moment, you’d finally feel just fine. This is also how one of my best friends explains it to me. He moved back home last spring to take care of some things, or so he told us. In August, my friend is sitting at my kitchen table at home, and Kristen is telling him all about the Worry Boss. My friend has never talked to another person with OCD before.
“I called it the Worry Boss,” Kristen says, “It helped to give it a name.” I understand it for the first time – I guess it’s easier to fight something if you can imagine the whole of it in your mind. My friend drove nine hours that day. At our kitchen table, Kristen tells him her story. There are parts that even I have never heard. “I had to touch everything, sniff everything,” Kristen explains, she giggles a little before adding, “I once touched all your toothbrushes. They were all in that container, and I touched every single one.” We laugh a little, but Kristen interrupts us to continue her story: “There was one night during my therapy, I must have been about eight years old, and that night I was not allowed to sniff anything. I remember getting tucked into bed, and I could just feel my hands wanting to rise up and pull the sheet to my nose, and I was just fighting and fighting the impulse, holding my hands down, and it was so exhausting. It’s hard to explain it.” She pauses. “It’s imprisoning,” she says. To most people, Kristen appears to be just fine. After completing years of therapy, she is able to control her OCD almost completely. Every now and then, a little crazy pushes its way out, but Kristen has the tools to fight it.
“I’m sorry, I’m being OCD, but I just can’t leave these dishes on the kitchen table,” somebody says. Kristen is very private about her OCD. Only a handful of her closest friends know about the diagnosis she received when she was eight years old, and the Worry Boss, and the toothbrush sniffing. She doesn’t understand why people use her mental illness as an adjective, but she’s not one to get angry. She would rather just not think about it. When I talked to her last night on the phone, I brought up the subject of college once again. “Oh, I’ll be fine,” she says, “It was like me going to Mexico! I was so afraid to go to Mexico, but Michaela, I had the best freaking time of my life.” I laugh, but before I can respond, Kristen is talking again: “And guess what, I flew all the way to Spokane last month by myself. Oh, and I sat next to this guy on the plane who was going turkey hunting. It was crazy.”