Does OCD Have a Relationship Upside?
A Q&A with psychologist and author, Michael Alcee
Before we dive into today’s content, I’d like to acknowledge that the past few weeks have felt overwhelming (understatement?). In an effort to reduce overwhelm for all—including myself—Relational Riffs will be transitioning to a bi-monthly cadence. Paid subscribers will receive additional content. And now, let’s riff on the upside of OCD with an incredible guest: Michael Alcee.
Today’s newsletter is a Q&A with author and clinical psychologist Michael Alcee, whose book The Upside of OCD: Flip the Script to Reclaim Your Life hits shelves on November 19th. I had a chance to preview this amazing book, and what struck me most were Michaels’s insights on OCD as a uniquely interpersonal condition. In this Q&A (and the book), you’ll learn about some relational upsides of OCD and how people like Charles Darwin use those upsides of OCD for good. You’ll read advice on how couples in which one partner has OCD can better understand and support one another.
Paid subscribers can enter to win a copy of this book (bundled with last week’s Q&A book, Super Psyched). Scroll to the bottom of this post to enter.
[This conversation has been lightly edited for clarity and brevity.]
What is Obsessive Compulsive Disorder?
Yael: Michael, can you start us off with a brief description of what OCD is, for those who aren't familiar?
Michael: Of course. So, the obsession part is that people think about things that they can't get out of their minds. They might have an intrusive thought like, “I might hurt my child,” “I've run over somebody,” “That doorknob has germs on it that I'm going to transfer to myself or somebody that I love,” or “If I don't say this the right way or do something in the right order, then something bad is going to happen.”
The compulsion side involves actions a person might take to deal with, or almost self-medicate, from this relentless doubt and fear. They might wash their hands a lot because of contamination thoughts or repeatedly check to ensure they didn't run over somebody by mistake or ask for reassurance that they didn't hurt somebody's feelings.
How does OCD relate to interpersonal styles?
Yael: One of my areas of specialization is treating couples where one partner has OCD. It's important to recognize OCD has a huge cost for relationships—and yet there is also an upside. How can we understand why OCD sets people up to be uniquely relational?
Michael: My book is trying to do what Susan Cain did for introverts in her book, Quiet. In my view, people with OCD—even before the onset of symptoms—have a temperament of empathic and emotional sensitivity. They are constantly thinking about the people around them—almost too much.
Ironically, a lot of the OCD symptoms are ways of trying to create boundaries. That's a thing that's misunderstood about OCD. There’s a method to the madness of OCD that is about individuals thinking about the people they care about so much that they start to doubt their own experiences. That gets missed in conventional treatments. And of course, OCD is disruptive to relationships because by the time somebody is dealing with OCD, they're driving the people that they love crazy.
Yael: I wonder if you can say a bit more about that? The idea that deep love in combination with OCD is a way of protecting the people that we love seems like a critical insight.
Michael: If you have so much empathy and love, you might also get scared off by your potential aggression and hate, which is part of being fully human. And I think people with OCD have a difficult time almost taking on that wildness.
Remember Max from Where the Wild Things Are? There's a way in which you have to incorporate that wildness, but it’s hard to incorporate when you're also very sensitive to how your own power and wildness can affect people. That's an important and subtle art. And people with OCD then have these rituals that, in a sense, provide space. It’s torturous, but it’s also an attempt of the psyche to figure out how to have healthier boundaries.
Yael: What pops into my head is that somebody who's highly tuned in and sensitive to other people's emotional experiences and cares very deeply might have all the big feelings—positive and negative. So, big love, but also big anger; big delight, but also big fear. OCD symptoms, including the rituals, may provide a way to structure and sometimes restrain some of the more negative impulses or negative emotions. Is that what you think is happening?
Michael: Yes. And it connects to the work you do with relationships, too. There's this wonderful poem by Stephen Dunn where he talks about “the reverse side.” It starts with a little epigraph that there's a Japanese proverb that says “the reverse side also has a reverse side.” For instance, when we feel immense love, we can also feel there is a reverse side to that, right? Just as you can deeply love your partner, when they do something that hurts you, you might also hate them. It's so difficult to be human in that way, particularly if you’re someone who feels things intensely.
People with OCD notice the potential for all this wonderful connection and all this potential death and disconnection. I call it the six degrees of Kevin Bacon because the one thing that comes with the Kevin Bacon of OCD is the fear of death. Everything with OCD comes back to death because that is the counterpoint to life. And most people with OCD are aware of the positives of connecting and also the lows of disconnecting. But they don't have many people to help them with the nuance. Just like the culture has a hard time dealing with polarization and being able to find nuance.
I jokingly say that I think people with OCD have Shakespearean range, but without the vocabulary to understand how that works.
Yael: It does seem like OCD is accompanied by a real sensitivity and intense awareness and insight into what it is to be human.
Michael: Yes, and in addition to having a very big heart, people with OCD have very imaginative and thoughtful minds. They will think of all different possibilities, and at its worst, they'll think of all the most difficult, painful things. But they'll also think of all sorts of amazingly innovative and creative things.
For instance, I write in the book about how Charles Darwin was an OCD-sufferer. He was extraordinarily concerned about the health of his children. His mother died when he was quite young. Most people think of Darwin as survival of the fittest, but as Dacher Keltner wrote, Darwin was more about the survival of the kindest. Darwin felt that empathic and moral sensibility was the thing that made humans truly amazing.
Yael: I loved the stories of Charles Darwin that you shared in your book. One that I related to was a story of Darwin having a conversation with a colleague and being so worried that he was misunderstood that he couldn’t sleep. His social anxiety, quite literally, kept him up all night.
Michael: It was poetic what Darwin studied and wrote about. He was so afraid of death in his own life. And what does he write about? How life goes on and evolves. This, to me, is part of the upside of OCD—that range and capacity. You can also have that kind of brilliant mind and open heart to do something like Darwin did or that Greta Thunberg, who also has OCD, does with her deep empathy for the fragility of our planet. These internal experiences can activate people to change the world for the better.
I wrote this book to tell people with OCD that there's so much more to you. There's so much more depth; there's so much more heart; there's so much more imagination; and there's so much that's right about you, not just this thing that's wrong about you.
Advice for people in relationships where OCD is present?
Yael: I'm curious what advice you would give to somebody who is in a relationship with somebody who has OCD in terms of how to respond to the pervasive obsessions or the compulsive behavior in a way that allows you to be compassionate and loving and appreciative without reinforcing behavior that is unhealthy?
Michael: One simple yet powerful move is to remember that people with OCD, like many of us who use our heads to navigate things, use their minds to deal with what they're experiencing. Helping a person with OCD begins not only with safety but also with permission to explore every kind of feeling that they might have, including the ones that are so-called negative or problematic. In other words, a person with OCD doesn't want to feel mean, selfish, jealous, or angry. So, a powerful exposure exercise would be for a partner to help give back to the person with OCD the same kind of empathy that they give to the world. Allow them to have space to be able to take on their feelings and also have their power.
You have to take up a little space to be healthy in this world. So, helping people with OCD take up space by validating that it’s legitimate to feel this or that. And it's legitimate, by the way, if you feel extreme ambivalence. That's not weird, crazy, or wrong. And you don't have to just be good. I jokingly said to one of my clients who struggles with OCD, I want to teach you how to be an a—hole (but not really how to be an a—hole).
Yael: What you're suggesting is that, as an ally, as a partner to somebody who's struggling with OCD, you can be helpful by leaning into encouraging and providing a safe space to sit with uncomfortable emotions.
Michael: OCD is very much a variant of high sensitivity. And it's important to appreciate that folks with OCD feel so much and then they try to use their minds to manage that. And, of course, our minds can only go so far, as we all know. We need to find a way to bridge the head and the heart, and the only way that we can do that is by being with the heart as well as the mind.
That's why I wrote the book, too—because I felt like the heart of OCD was missing from the literature. And that to me was heartbreaking because, as most clinicians know, when you work with someone with OCD, they're amongst the kindest, smartest, and loveliest people with whom to work. So, I just want to champion that.
And I also want people with OCD to own that a little bit more. Because people with OCD have a little bit of modesty about their power. And they also have a caginess around their power because they're afraid of being hurtful with that power.
Now Jacinda Ardern, the former Prime Minister of New Zealand does not have OCD, but she's highly sensitive and a great example of someone who finds a way to use that sensitivity. During the pandemic, for example, she not only made sure that New Zealand was locked down, but she also talked to her citizens in her sweats after putting her child to sleep, sharing how challenging it was, but that they were going to get through it together.
The depth of empathy that you find within OCD is not just for people who have OCD and the people that you know and love. It's also something that can have the power to change the world because we need more empathy in this world.
Yael: That’s an understatement! Ok, so I asked for your advice for the partner of somebody with OCD, but as much as it’s painful to struggle with OCD, it can also be painful to be partnered with someone struggling with OCD. So, what advice would you give somebody who has OCD in terms of understanding what their partner's experience is like?
Michael: So, you're correct that when a person becomes preoccupied with their anxieties, they become completely unempathic and self-absorbed. In John Green’s book Turtles All the Way Down, the main character is a teenager with OCD. Her friend says, ‘When you get worried about your stuff, you don't even know who I am. You don't even know what my mom does for a living. You don't even know my favorite anything.’ And it's true. So, I think it's important for people with OCD to realize that it's healthy and helpful to understand that sometimes when they're in the throes of their own spirals, they can make the other person feel temporarily unimportant.
Yael: You know, some of the most pivotal moments in couples’ therapy are when the person with OCD can acknowledge how invisible their partner sometimes feels because the OCD just occupies so much internal real estate. It can crack things open in a good way.
Michael: It's beautiful when that happens. And it could be a joining moment for both people. Because just as the person who does not have OCD feels invisible, they now have a sense of how invisible the person with OCD feels all the time. And if you can find a way to join that together and say, “Let’s find a way to take up space together.” That, to me, is the antidote.
Yael: It’s the upsides of OCD, beautifully captured in your book title. I'm so glad that we finally got to talk about The Upside of OCD together.
Michael: I've been waiting. They say that writing a book is like telling a joke and waiting three years to see if the punchline landed,
Yael: It landed!
You can order Michael’s book, The Upside of OCD, by clicking the button below.
Paid subscribers can enter to win a copy of both Michael’s book, The Upside of OCD, and Adam Dorsay's book, Super Psyched (which was the topic of our newsletter last week). Entries will be collected until November 30. (Advance apologies but winners must live within the US).
Considering how mental health problems interact with relationship functioning is an important area I’d like to explore more deeply in this newsletter. If you have specific questions on this topic, feel free to post here or message me directly.
Before I sign off, I want to say a quick something about the recent election—despite recognizing that there are already too many talking heads in this space (it’s one of the causes of my own overwhelm). In my overconsumption of news in the past week, a line from an article by Ezra Klein (who wrote Why We’re Polarized) has been reverberating in my mind. He writes that in times of divisiveness, there are two ways to respond: “contempt or curiosity.”
Obviously, curiosity is the more productive pathway to take. But how do we do it? How do we listen when we feel full of fury? When we don’t share the same reality? When we see “the other side” as immoral, ignorant, or stupid? Tools from relationship science and the couples’ therapy room offer much-needed guidance.
I’ll continue to share tools in upcoming newsletters. In the meantime, consider checking out some of our past posts.