We Won't Get Fooled Again
The Surprising Repetitions In OCD Treatment
“Meet the new boss. Same as the old boss.”-The Who (Listen to the full song here)
OCD was originally treated by psychoanalysis. It was ripe for showcasing the profound conflict and ambivalence of the human psyche. Here was a person tormented by sexual and aggressive thoughts who felt compelled to atone for their sins. What was taboo must be purified, but it never was enough.
Although psychoanalysis examined how these symptoms got activated in human relationships—how they might be triggered by the inevitable love and hate of romantic and family connections—the field moved steadily towards an interpretive stance and a one-person psychology.
These conflicts could only be resolved if you were thoroughly analyzed, and the analyst was the expert who could decode your unconscious. It was just about healing a pathological subject and reclaiming their healthier adaptation to reality. Sound familiar?
The problem was that this treatment became too cerebral and academic. It didn’t focus on the massive everyday costs of performing obsessions and compulsions. To sufferers, it felt like just wasting so much time and money, and worst of all, feeling betrayed by those who were supposed to help.
And then the cognitive-behaviorists came along to rescue OCD sufferers from neglect. A treatment emerged that showed them that not only could they face their fears, they now had therapist-coaches who truly cared about zeroing in on the science that was causing it. They could feel hope again, and they could function.
Exposure-response prevention led the way, and then ICBT came along to showcase that it was the loss of touch with the senses and an unruly imagination causing inferential confusion. Again, there was so much hope that OCD sufferers wouldn’t get fooled again by pseudoscience, so much so that talk therapy became a slur.
Talk therapy was the biggest part of the problem, and it shouldn’t be accepted again. We won’t get fooled again.
What OCD sufferers didn’t realize is that these new treatments—both ERP and ICBT-were one-person psychologies too. OCD was just inside you. You were the problem again, and now there was a new expert: the ERP or ICBT practitioner who could decode your OCD.
Because these symptoms were cognitive and behavioral, they weren’t dream-interpretation hocus pocus and were perfectly legitimate. Besides, as they loved to say, it’s empirically validated.
It works now, there’s no more wasting your time and money. You won’t get fooled again.
It’s you, hi, you’re the problem, it’s you, to echo Taylor Swift’s “Anti-hero.” It’s your misfiring and overactive brain, and whatever activates your OCD is of no importance.
The famed slogan became “the content doesn’t matter.” Going into the content of your obsessions and compulsions was merely a trick, and we learned better of that.
You don’t need to be fooled again.
To sketch some finer distinctions, the ICBT people are the closest to noticing that OCD still requires understanding of context. They recognize narratives about oneself that get activated and feared selves that haunt people with OCD and that these are very personal and particular. BUT, they don’t require any interpersonal work.
Why not? This would lead you to get fooled again by the trauma of psychoanalysis.
Happily, over 50-75 years, psychoanalysis has changed. It’s no longer a one-person psychology with a blank-slate analyst who doesn’t share any of their personal feelings and interprets at a distance. It’s no longer a smug, armchair philosopher posing as a scientist.
Contemporary psychoanalysts are impeccably sensitive and tuned into the ever-shifting currents of self and other in relationship. They are willing and able to talk about the ripples, waves, and even tsunamis of affect that so often occur in close relationships. They are alert to how close chaos is to emergent creativity.
Partners in thought and feeling, they aren’t just experts, they are fellow travellers. Humbler, they take more emotional risks, the kind one might even say are like exposure exercises. Who’d have thunk it from where they started!
So, we have this ironic and repetitive dance in the field, but it doesn’t need to persist. It’s possible to take the better and best of it all.
Take the openness of noticing emotional and cognitive conflict from the early psychoanalysts, lean into the wisdom and efficacy of doing well-crafted exposure exercises, and explore the ways your imagination runs wild and takes you away from your feared self but then, if you lean into it might also bring you back to your hidden talents like Jack Anontoff shows or Charles Darwin discovered.
And also do this. Make sure you’re able to talk about your relationships and how they affect you, both in your life and in your therapy, so you can practice even more fully how to get back to yourself.
We don’t just live with misfiring brains, we live with exquisitely sensitive minds and hearts that are messengers. They constantly remind us that our sensitive, imaginative, and creative sensibility isn’t always supported in the world or in relationships, but it must be honored and supported for your healing and growth. It must be claimed and reclaimed as valuable in its own right. This is the beauty and power of being a subject and not just an object, what is so easily overlooked in the history of OCD treatment.
When we witness the wonder and wisdom of this hearbreakingly beautiful human condition we all share, we dream reality into life.Or as Freud once put it: “when we can share, that is poetry in the prose of life.”
In short, we don’t need to be fooled again, but we do have to keep noticing the subtle ways it’s challenging to claim our own centers while being so open to the world.
It’s not easy to be so moved by things, but when we learn how to better understand, express, and protect ourselves, we are able to enjoy our many gifts and minister to our most understandable vulnerability.
That’s nothing to be fooled about, thats worth celebrating.