Patients failing at treatment, or treatment failing patients?

Posted on: June 8th, 2021

It is thought that up to a third of people with Obsessive Compulsive Disorder have what is called TreatmentResistant OCD, which means they do not respond to standard treatments like medication and CBT/ERP/psychotherapy.

When OCD has become deeply and chronically embedded in the circuits of the brain, it is extremely hard to shift. It becomes embedded by the vicious circles of thought and behaviour established when a person feels strongly and urgently compelled to follow the ‘command’ of OCD without question.

In the experience of some people, there has been an implication during treatment that they are not cooperating, not ‘engaging with treatment’, not doing what they ‘should’ be doing, so there is nothing more a therapist can do.

In the case of one individual, an appointment with her local Eating Disorder Service was cut short, because she had already been given a ‘final warning’ that if she continued to scratch her hands, the appointment would be terminated. The scratching relieved the escalating OCD-induced anxiety she had been feeling from the beginning of the session. It was an impulsive/compulsive action that occurred when she was caught up in the tangle of intrusive thoughts in her head.

On another occasion, when her treatment was being reviewed in a hospital unit considered to be a ‘National Specialist Centre’ for the treatment of Severe OCD and Anxiety Disorders, she was deemed ‘too anxious to engage with treatment’.    Yes, a specialist unit, ‘treating’ people with Severe OCD and Anxiety Disorders.

Respect, Compassion and Understanding are, I believe, essential components of any medical treatment, whether that treatment is for a physical or for a mental condition.

Knowing what we know about the horrors of OCD, does it not add insult to injury to suggest that the patient is at fault; is the person to blame for the treatment not working? The patient who despairs more days than she doesn’t:- ‘WHY can’t I do it? WHY can’t I crack this thing’? Who feels so desperate at times that she doesn’t think she should go on living. Her despair is not so much despair at what her own life has become, as despair at the impact her OCD is having on her family and those around her. Particularly her mother, who she lives with. Her thinking is ‘‘I keep trying to beat this thing, and yet I can’t. I cannot carry on ‘Doing what I am doing to Mum’, so there’s only one solution…’’.

My plea to mental health practitioners at every level is to consider very carefully before condemning anyone for ‘failing at treatment’.

To ask instead –

Why is this particular treatment failing this individual?’

What can we do differently, to make it work?

What can we do to keep this person safe? Alive?

How can we help this individual find a better quality of life?

It is our hope that Psilocybin will prove to be an effective treatment for people who have not found anything that works for them. Yet.

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