Welcome to the first episode of SEASON 2 of Lively Minds!

In this episode, we will be talking to Stuart Ralph who featured in what is currently our most popular episode of season 1, exploring OCD: Obsessive Compulsive Disorder.

Stuart is a counsellor and psychotherapist for children and young people, who has lived experience of OCD, is the co-founder of the Integrative Centre for OCD Therapy and host of the very popular OCD Stories podcast which we recommend you check out.

In today’s show, Stuart will be chatting to us about a strand of OCD known as “Pure O”. We’ll be finding out what it is, why - despite its existence being contested, why the term has been embraced by so many within the OCD community.

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Please note that this show does not constitute medical advice and is not a replacement for seeking professional help. You can find our more about the show and get signposting to support on our website anyamedia.net/livelyminds

--Show Transcript--

[music] W: Hello, my name is Will. E: And my name is Ellie. W: You are listening to Lively Minds, the podcast about mental health challenges that go beyond the ebb and flow of the everyday. E: The podcast that looks at how developing our understanding of mental health issues influences how we address them. W: In this episode, we will be talking to Stuart Ralph, who featured in what is currently our most popular episode of season one, exploring OCD, Obsessive Compulsive Disorder. [music ends] E: Stuart is a counsellor and psychotherapist for children and young people who has lived experience of OCD, is the co-founder of the Integrative Centre for OCD Therapy and host of the very popular OCD Stories podcast, which we really recommend you check out. W: In today’s show, Stuart will be chatting to us about a strand of OCD known as Pure O. We’ll be finding out what it is and why, despite its existence being contested, the term has been embraced by so many within the OCD community. Welcome back on the show, Stuart. S: Thank you for having me back on. I’m honoured to hear that it’s the most popular episode! That’s really flattering and great to be back on talking with you guys. W: Thank you. It’s great to have you. E: To begin with, could you remind us, particularly for the benefit of people who aren’t so familiar with it, how you define OCD? S: Yeah. So it’s best just to break it down into the O and C. So obsession, compulsion. Obsession could also be named intrusive for, image, urge, impulse. Often they call it ego dystonic. It’s against what we want. It’s repugnant to us. That’s why it’s scary to the person. They don’t want these thoughts and feelings, these sensations. they want none of it. They can come in different themes, sometimes called subtypes of OCD. It could be worried about physical contamination, emotional contamination, worrying about offending your God. You’d call that religious OCD, obsessively worrying about your romantic relationship, called relationship OCD. Worrying about sort of harming someone, hurting someone, killing someone. We might call that harm OCD. You could also have paedophile-themed OCD, which is where you’re worried that you’re a paedophile. And of course, people that have those worries, far from being a paedophile, they’re deeply disgusted and scared by that thought. Because they’re deeply disgusted and scared by that thought, they then do compulsions. Compulsions are any actions in our heads or in the outside world, like mental reviewing is a mental compulsion going over memories or facts and figures. Physical compulsions could be googling, it could be checking, it could be flipping a light switch on and off, washing your hands, hiding knives if you’re worried about killing someone and the reason they do compulsions is to get rid of, remove, reduce, the thoughts and feelings. And then I just mentioned feelings, so that’s not in the title OCD, but the feelings are really what fuels OCD so it’s usually anxiety although it can also be guilt, shame, disgust you name it that also drives the OCD but it’s more common that it’s anxiety but I’ve worked with clients that don’t really have much anxiety and it’s mainly disgust or guilt is the driving emotion behind it. And quite often if we didn’t have those, I say we, because I’ve experienced OCD, I talk a bit about my story in the first episode. When we don’t have those feelings, it doesn’t really matter if we have intrusive thoughts, obsessions, because they don’t bother us. So there was a study done, it’s probably over 10 years ago now, it was like 94 and 96% of people have intrusive thoughts. So that was general public that were questioned and I think the other, whatever it was, 6% was probably lying or just didn’t realise it. But we all have that image if we stand too close to a train track our brain throws us on the tracks. Most of us have had that thought right? Or you’re holding your kid and suddenly your brain throws your kid down the stairs. Not literally but in your mind. That’s an intrusive thought, it’s scary. Now, but if you’re seriously anxious at the time of having that thought, that thought sticks around and it becomes more and more recurrent in your head and it will keep coming back and back and that’s the OCD cycle and then we do compulsions and what the compulsions teach our brain is that this thought is, could be real, it could be a real danger, because it’s a real danger I better do these safety behaviours or compulsions, but that just reinforces the cycle and teaches our brain we should be afraid of these thoughts therefore we end up doing more compulsions because we’re more anxious, so it’s this vicious cycle of OCD and it really keeps people trapped. The last thing I say about it is these thoughts are so far fetched often, they’re so far out there. You know just because I had a thought about let’s say Jesus in some kind of sexual way and if I’m a Christian, I might get super worried about that, of course I don’t want to do anything sexual to Jesus, but because I’ve had that thought I’m now obsessed worried about it and can’t stop thinking about it, praying compulsively. That’s just teaching my brain the thought could be real and I get stuck in this cycle. But it’s just far-fetched, right? E: Thank you. That’s really thorough, today we’re going to talk about something called Pure O which I wasn’t too familiar with until we spoke to you and Will told me about it after the first episode you did with us. So what is Pure O and how does it differ from more traditional understandings of OCD? S: Yeah, so Pure O is, is highly contested and arguably a bit controversial, which we’ll talk about in a bit, but its, it means purely obsessional, right? So the assumption is there are no compulsions. Now that is the problem with the wording of Pure O, because there’s always compulsions. But the compulsions for people with Pure O are mainly in their head. So they’re doing compulsions in their head as opposed to the physical world. That’s not entirely true, and I’ll share that in a bit when we talk about maybe the issues with the term of Pure O, but in theory it means compulsions are in the mind, not in the physical world, so I’m mainly doing compulsions like checking memories or making lists in my head or saying words in my mind to counteract the thought. It’s those sort of things and it’s also a word for, that could be called rumination. We all ruminate but with OCD it’s very prevalent. I could just call that seriously overthinking. So that’s where it, it got its name. Now it was coined by Dr. Steven Phillips and he’s been on my show like 10, not 20, 10 to 12 times and he coined the term in 1988 because he was seeing a lot of clients come through his practice who didn’t seem to have any physical compulsions, were having these intrusive thoughts often quite taboo intrusive thoughts like violent sexual intrusive thoughts, and they were being missed in the research. So he coined the term to try and bring them into the term OCD. Now they were always OCD but they were getting missed by other therapists and researchers because they didn’t seem to be washing their hands or checking things over and over again in the real world. So that’s where Pure O came about and it’s been a very useful term because it’s helped people find others who don’t seem to have many physical compulsions. So it’s helped them find a tribe and again I think we’ll talk about that later. But yeah, in short, it’s just where there’s not any physical compulsions or many and it’s mainly mental compulsions but the issue with the wording is purely obsessional to anyone outside would say well that means there’s no compulsions because it’s purely obsessional right? if we’d be very anal about it and that’s why a lot of, not a lot, there are therapists and researchers out there who hate the term. And there are many therapists that actually like the term for the reasons I’ve said that it’s helped people find a tribe. So it’s a real, it’s a problematic term, but it also has had a lot of uses over the years, good uses, and has helped a lot of people feel understood. But yeah, just that misconception of, if anyone says they’ve got Pure O and they don’t do compulsions, lie, unintentional lie, they are doing compulsions, just mainly in their head. W: Yeah, as ...