“Mr. Donaldson reported a long history of obsessive thoughts and compulsive behaviours dating back to his childhood. He explained that when he was younger, he engaged in numerous checking behaviours (eg. checking the heater of windows a certain number of times before going to bed) and superstitious behaviours (eg, he would have to say goodnight to his parents in a certain way and if he did not do it correctly, he would have to do it again. His OCD symptoms decreased through his adolescence, but flared up in November 2000, and have gotten more severe since. [...]
He reported that he spent considerable time focused on his obsessions, resulting in severe interference in his life. Although he tried to resist the obsessions, he had little control over them.[...]
Given Mr. Donaldson’s openness to psychological interventions, previous successful experience with cognitive behavioral techniques for managing his OCD symptoms, motivations for treatment, good insight, and lack of comorbid psychological conditions, prognosis is cautiously optimistic.”

- Intake Evaluation, from an interview conducted by Rami Nader, Ph.D, on October 24, 2005

In the fall of 2005, my parents sensed that something was wrong and scheduled an appointment with my GP. As a result, I was given a referral to the UBC Anxiety Disorders Clinic, the only government-funded treatment option in the province.

I waited three weeks to hear from them.

Four.

At the end of the second month, I made a phone call, and was told that the facility had a wait list in excess of five years. There was also the chance that I’d be unable to receive treatment at all. The woman on the phone used the phrase “no guarantees”. Shortly thereafter, the clinic closed its doors forever, to be replaced by the Operational Stress Institute, a publicly-funded program which deals with instances of Post-Traumatic Stress Disorder in Canadian Police and Military Officers. Currently, there isn’t a single provincially-funded option available within the City of Vancouver specifically for individuals with anxiety-spectrum disorders. And, considering that, of the 900,000 individuals affected by mental illness provincewide, 400,000 of them are suffering from an anxiety disorder, this leaves few real options: either take one’s chances with a VGH Outpatient Team, explore a few group-based options run by non-medical personnel, or pay $160 per session for psychotherapy at a fee-for-service clinic.

“The [UBC] clinic doesn’t exist anymore, because UBC decided that we don’t have anxiety disorders in BC,” explains Dr. Charles Brasfield, his voice layered with sarcasm. Brasfield is the former consultant to the UBC Anxiety Clinic, as well as former Clinical Associate Professor in UBC’s Department of Psychiatry, and the province’s only psychologist/psychiatrist. “VGH had a pretty good outpatient program for difficult anxiety disorders and personality disorders; a dialectical behaviour therapy program,” he continues. “It was discontinued last year. The DBT program now at UBC is entirely private. You can access it, if you have, you know, $3,000.”

Brasfield is also the founder of the North Shore Stress and Anxiety Clinic, the only cognitive-behavioural option in the province for individuals with anxiety-spectrum disorders. The operation employs two psychiatrists, 16 psychologists, two nurses, and takes in close to one million dollars per year. Brasfield is an affable, intelligent, soft-spoken fellow, who divides his time between the North Shore, and remote First Nations communities in BC’s North, where he is involved in outreach work. Brasfield’s expertise is formidable, and, according to him, while the treatment of anxiety disorders is never easy, the process is less mystical than many would believe.

“Panic Disorders, we can deal with in half-a-dozen sessions,” Brasfield explains. “Specific phobias, about the same. They’re simple for us- we’ve all done this for years. We know how it works. We know what the pitfalls are, and what actually helps. Chronic anxiety disorders -PTSD, they’re all about 8 months or so.”

My own psychotherapy program lasted 6 months. The clinic’s approach involves a combination of medication and cognitive-behavioural therapy (CBT), which, as the name suggests, deals with treatment on two fronts. On the cognitive side are number of homework assignments called Thought Experiments, meant to challenge faulty ways of thinking (known as Cognitive Errors), and shine some light into the quiet, private, muffled hell you’ve created for yourself. To contest the assumption that every thought is true and meaningful, a patient is made to record everything that passes through their brain for thirty minutes, and afterward rate its importance. As a challenge to the superhuman amounts of harm you’re afraid of causing, (the harm I imagined causing my girlfriend, for example, was near-catastrophic) you’re made to imagine and document the worst-case scenario of your fears on a chart.

It all leads toward the understanding of a single idea: that thought you had? The one that disgusts and terrifies you? That one you’ve spent days, weeks, years avoiding, or explaining away, or neutralising through compulsions?

It could be true. And there’s no way you’ll ever be sure.

The first day I uttered those words - the first day I wrote them up on my laptop, printed them, and posted them prominently on my bedroom door - was the first day in four years that my life made any sort of sense. Granted, it was a perverse and horrifying kind of sense, but it was something.

It could be true. And there’s no way to be sure.

There’s no cop-out, there’s no brush-off, there’s no attempt to soften the blow.

It’s called Acceptance, and it’s stage five.

The behavioural component of CBT is pointed toward the same goal, but it’s an altogether different beast. While Thought Experiments address the psychological, subtly forming new neural pathways, Exposure and Response Prevention (ERP) is the therapeutic equivalent of a punch in the guts. Rather than avoiding fears, it forces the sufferer to confront them head-on - not just once, and not just for a second, but for an hour each day, until finally, through the process of habituation, those stimuli no longer provoke an anxiety response

You work with a therapist to create an Exposure Hierarchy: a list of potential triggers, ordered according to their potential for anxiety. Sufferers then subject themselves to these triggers, paying close attention during the process, and noting their body’s anxiety response on a scale of 1-10. Once a stimulus no longer causes anxiety, it is retired.

Although I had to make several (one for each spike theme), mine started off tamely enough: say “I’m Gay” out loud. Watch a television show with a gay main character. Write a breakup letter to your girlfriend. Punctuate it with actual failings or issues. Read some homoerotic literature. Eventually, it moved to soft-core erotica. Naked pictures. Reading my breakup letters out loud. And finally, weeks and weeks of the most explicit gay porn imaginable. Acts that would make legitimate homosexuals blush. Picking the most unattractive photos I could find of my then-girlfriend, and putting them in frames nearby.

Anxiety spikes are sadistic creatures; they grow and change as time passes, evolving to fit the freshest of insecurities. And, as a result, there’s an attitude that begins to develop during the early stages of ERP; an idea equally quiet, and equally sadistic. After so many years of being a slave, you begin to get a sick thrill out of your own suffering. You can watch yourself go through some of the darkest moments of your life, but, as you watch, you begin to, in a small way, relish the pain. Thrive on it. Because you realize that through it comes relief. Recovery. Management. Because, for the first time in your life, you’re not running from your fear. You’re not avoiding it. You’re walking straight toward it. You’re looking it square in the eye, and even though you’re sweating bullets, and even though you want nothing more than to turn and bolt, you don’t even slow your step.

Instead, you open your arms, smile, and say “Bring it On.”

You’ve trained yourself to be so at peace with your own uncertainty that, if someone were to ask you about the content of your obsessions, you’d no longer have a definite answer for them.

If someone asked whether you really loved your girlfriend, you could say “Maybe”.

If someone asked whether you were gay, you could say “I don’t know.”

Funny to think that, after all that time, the ultimate expression of your liberation could be nothing more than a shrug of the shoulders.

Helen Keller once said “Security is mostly a superstition. It does not exist in nature, nor do the children of men as a whole experience it. Avoiding danger is no safer in the long run than outright exposure. Life is either a daring adventure, or nothing.”

I left psychotherapy in May of 2006, and, in the five years since, thanks to the tools developed there (not to mention some medication to even out the physiology), my disorder has been more or less managed. Of course, there are still rough days - days where I feel like I spun the wheel in some random genetic lottery, and came out as a colossal fucking loser. But there are also days when I feel nothing but gratitude that I found treatment at all. That I wasn’t born fifty years ago, to be condemned to Riverview for a life of Insulin Shock treatments. That I don’t live in BC’s north, where there is zero support, few services, and the only option is to move away or die. That I had a decent-paying job and supportive parents who could help me come up with the more than $3,600 that private treatment cost. Not everyone is so lucky.

I met a girl recently, through mutual friends. She was the first “fellow” Obsessive-Compulsive I’d ever encountered, and, when we met, she was entering her second decade of symptoms. Naturally, I made mention of medication and CBT, and, though she listened, it wasn’t information she was ready to hear. Instead, she told herself to toughen up. Figure it out. Get on with her life. And as she told herself this, she watched everything around her fall apart. For her, it took a visit to the emergency room to put things into perspective. But, when she picked up the phone to figure out what to do next, I’m honoured that she called me. Thanks to that discussion, she’s now in CBT, and, after more than ten years, on the road to managing her symptoms.

There are close to a million British Columbians affected by mental illness each year. Of that million, 400,000 are affected by anxiety disorders, and 75% of them will never seek treatment of any kind. Some of these people have no options. Either due to addiction, or poverty, or simple circumstance, tens of thousands of people in this province will need assistance, and they won’t get it. Some will have that chance. And those people need to know that there is a future. Need to know that, at the end of the road, with a lot of work and a lot of money, there is recovery. There is relief. There’s a breath. There’s the reality that, one day, you’ll be looking back, and realize you did something that millions of people everywhere have never done: you looked your worst fear square in the eye, and you didn’t back down. You laughed in the face of your tormentor. You faced the single greatest challenge of your life, and you beat it. And, what’s more, you can beat it again. It’s knowing that you have the tools to manage yourself. That you know yourself more intimately than most people you’ve ever met will ever know themselves. That you’ve been to the edge of your fear and come back again, and that, if you’re willing to put in the work, you need never fear a single damn thing ever again.

The only liberation is uncertainty, and the only solution is acceptance.

Or maybe it isn’t.

There’s really no way to know.