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I MAJORED IN PSYCHOLOGY in college and later went on to get a master’s degree in social work. I knew that I eventually wanted a career in psychotherapy, but beyond that I didn’t really have an idea of any particular specialty. That changed in 1982, when I was employed as a social worker for a large nursing home in San Francisco. It was my job to tend to the psychosocial needs of the residents, which required getting to know several hundred people. On one occasion, I was asked to visit a 91-year-old woman who hadn’t let anyone into her room for several months, with the exception of infrequent visits from nurses and her doctor. The social worker before me had worked there for several years and had seen her only a few times. Now it was my turn.
The first time I knocked on her door, she didn’t respond. This was true for many a time after that. I don’t recall how many times I walked away without meeting her, but one day the door opened. I’d been told that she was diagnosed with obsessivecompulsive disorder (OCD), and although I had some idea what that meant, I was unprepared for what I saw. She, and everything in her room, was covered either with cloth or paper towels. In fact, she opened her door while holding a tissue and asked that I sit down in a chair that was covered with towels. Her entire apartment and everything in it—pillows, blankets, bookshelf, window ledge, television, radio—and her body were all covered in towels.
We actually got along quite well. I would visit her most weeks, and she would tell me various stories about her life. It wasn’t my role to do any psychotherapy with her, and I’m doubtful she would have allowed that anyway. I don’t think we really even discussed her OCD much, with the exception of her telling me that she was protecting herself from germs. She warned me to be more careful when it came to touching items around the facility because the place was fraught with all sorts of dangers. In her mind, living in a nursing home meant no shortage of life-threatening situations she could encounter.
This was my first exposure to someone with OCD. I was so fascinated with her stories and behavior that I used her as my case to present to the California Board of Behavioral Sciences for my licensing exam. I learned all I could about OCD and later became a member of the International OCD Foundation (IOCDF), which at the time was called the Obsessive-Compulsive Foundation. Shortly thereafter I became a founding member of the board of directors for OCD San Francisco, an affiliate organization of the IOCDF. As my specialty in OCD grew, I learned that I liked to teach and began offering workshops throughout the country on both OCD and body dysmorphic disorder (BDD). I’ve taught at many continuing education programs throughout the country, including those that are university-based and those offered by private companies. I’ve given numerous presentations at the IOCDF annual conferences and developed an anxiety disorders certificate program for the University of California at Berkeley Extension. To date, I have probably trained several thousand therapists in the treatment of OCD, BDD, and anxiety disorders.
For 27 years, I worked at Palo Alto Medical Foundation Department of Psychiatry and Behavioral Health. It was there that I truly developed my specialty. For about 20 of those years, I ran an OCD treatment group in addition to seeing patients individually. During much of that time I also participated in my private practice. In 2008 I opened the OCD-BDD Clinic of Northern California. Today I work exclusively in my practice, where approximately 90 percent of my patients have either OCD or BDD.
When I first considered writing a book on OCD, I wondered what expertise I could offer that doesn’t already exist in other books. I thought that perhaps a book that focuses almost exclusively on treatment was the right way to go. I knew that I still needed to offer the basics of describing OCD, but I didn’t want to spend too much time on that, since this book is really written for people with OCD themselves—the individuals who know more about it than anyone. In this book I focus more on how to get to the problems associated with the disorder as quickly as possible. What you’ll find here is an introductory chapter on the disorder, then a deep exploration into treatment. Much of the book concentrates on exposure and response prevention (ERP) therapy, the gold standard for treating OCD. Along the way we will also explore other forms of treatment that over the years have become part of the tool kit in treating OCD. This includes cognitive therapy, acceptance and commitment therapy (ACT), and the meditative practice of mindfulness.
Given that this is a workbook, you will be put to work. There are opportunities throughout for you to address your own obsessions and compulsions. Together we will look at building an effective, long-lasting plan to help you learn how to gain better control over your OCD.
One final note before we get to chapter 1: You’re not in this alone. As I tell my patients, treating OCD is meant to be a collaborative effort—you and me working as a team to overcome the disorder. I know that you’re going to be doing most of the work, but you’ll have my guidance along the way. I want you to know that we’re in this together.
A DISCLAIMER
AS YOU WILL NOTICE THROUGHOUT THIS BOOK, OCD comes in many, many forms. You likely already know about several of them, but some are possibly going to be new to you. Some may seem to be quite silly while others may seem downright scary. In the latter category are the obsessions associated with harming oneself or harming others as well as those pertaining to intrusive thoughts of sexual content, such as child molestation. It’s all OCD. Most people will agree that the more commonly recognized forms of OCD, such as compulsive handwashing and the checking of doors, make little sense. The same is true for the more disturbing obsessions you are going to encounter in this book. They, too, make little sense.
I react to all forms of OCD in the same manner: The obsessions and compulsions have nothing to do with someone’s character. They merely are manifestations of the disorder. I do recognize, however, that the harm and sexual obsessions are often the most troubling. Even so, they are still just symptoms of OCD and are not any more significant than any others. So, if you are shocked by some of what you read, please put it in the proper context of it all being part of the same problem.
Exposure and response prevention therapy will be thoroughly explored in this book, as it is the treatment of choice for OCD. It is important that readers understand that exposing themselves to fearful thoughts is a necessary part of the process. Our goal is to get you to the point where these troubling thoughts lose their hold over you. No one can ever promise you that these thoughts will go away entirely, so instead our focus needs to be on learning to live with them and getting you to the point where you are more in control of them than they are of you.
I often recommend books to my clients, but sometimes people tell me that they are afraid to read them because they don’t want to read about people who are also struggling with OCD and about their troubling obsessions and compulsions. While this workbook is meant as a guide to assist you in learning the tools needed to better cope with the disorder, some of what you read may trigger uncomfortable
feelings for you. That is normal and to be expected. Read the book at a pace that feels manageable to you, but read the book completely. If you find yourself triggered as you read, take that as an opportunity to do more exposure therapy. If you experience the temptation to skip over sections you find to be especially troubling, it’s a sign that those are the parts to which you need to pay particular attention. Avoidance is a primary coping strategy for many people with OCD. It’s also a very ineffective one, as I’m sure you have found. Please stick to the reading and do the suggested exercises. If you do so, I’m confident that you will find it to be an enlightening and ultimately rewarding experience.
PART ONE
UNPACKING OCD & EXPLORING TREATMENT
Over and Over Again
LIVING WITH OCD CAN BE VERY HARD; so is the process of learning the skills that you need in order to cope with it. I’m hopeful, however, that you will find the progression ultimately very gratifying. So, congratulations on taking this first step toward confronting your disorder. As you embark on the journey of gaining better control over your OCD, this first chapter will explain what the term actually means, from both a day-to-day perspective and a clinical one. These days, it’s common to hear the phrase “I’m so OCD” jokingly tossed around. It’s highly unlikely that people saying that really understand what the disorder is all about. This chapter will look at what it means to truly have OCD and the many ways it can manifest itself. We’ll start with a story of someone who has lived with OCD, then take a look at possible causes of it, followed by an overview of how I believe this book can be of help. CHAPTER ONE
I Keep Getting Stuck
Kevin is a 14-year-old high school freshman who first began showing signs of OCD when he was in sixth grade. When completing homework assignments, Kevin often felt the need to erase his work if one letter touched another. Unlike many people with OCD, Kevin wasn’t worried that anything bad would happen to him or anyone else if he didn’t perform this task. Rather, he was overcome by the feeling that he had to complete his work in a certain way until it felt right.
At that point, no one who knew Kevin saw this behavior as OCD related but rather as an unusual quirk. But it did create problems for him on tests. Kevin would typically run out of time to complete them. He usually knew the answers, but he just couldn’t finish the work fast enough. Even though Kevin didn’t complete many tests and assignments, he managed to get through middle school and was promoted to high school.
This manifestation of the OCD seemed to subside some over the summer months, but when Kevin returned to school in the fall as a freshman, everything shifted. Now the OCD started to exhibit through other behaviors that involved walking, closing doors, and turning off lights. Again, he wasn’t worried about anything bad happening to him or anyone else if he didn’t complete these tasks—a common thought among many people with OCD. Instead, Kevin felt compelled to behave in a certain manner until the anxiety went away. Once the behavior was completed, that was when he would achieve that “just right” feeling.
Walking became particularly problematic. Whenever Kevin saw a line or a crack in the pavement, he had to step back and forth over it three times while also turning his head to the right. This was very different from his previous OCD behavior. With homework, it wasn’t evident that Kevin was doing anything unusual, but now his behavior was more obvious. This led Kevin to feel embarrassed and ashamed of his actions. The behavior didn’t happen just at school. It happened at home, while hanging out with friends, and when in public.
When Kevin’s parents began to notice an increase in these behaviors, they took him to his pediatrician, who suggested that he might have OCD. He was then referred to me. When Kevin told me about his symptoms, I knew right away that he was experiencing “just right” OCD. I explained to him and his parents that this common form of OCD essentially describes people who have to complete an action (and/or thought) until they feel “just right.” While many people with OCD may worry about bad things happening to themselves or loved ones under similar circumstances, Kevin instead experienced an uncomfortable feeling that wouldn’t
go away unless he completed the required compulsion. As is often the case for many people and families living with OCD, Kevin and his parents were relieved to know that there was a name for his problem. They were also thrilled to learn that there is effective treatment for it. At the same time, they were also understandably frightened over what it might mean for his future.
How about you? What’s your reaction to Kevin’s story? Does it resonate with you in some way?
Kevin’s story demonstrates just one of the truly countless ways OCD can manifest itself. As we explore the meaning of the terms obsession and compulsion and how people develop this disorder, it’s important to reference the Diagnostic and Statistical Manual of Mental Disorders (DSM). The manual, currently in its fifth edition, lists all psychiatric disorders. The DSM-5 describes obsessions as a “recurrent and persistent thoughts, urges, or images” that are intrusive and unwanted and create marked anxiety and distress in most individuals with them. The compulsions are described as “repetitive behaviors or mental acts” that are performed in response to the obsession. Kevin’s obsession essentially pertains to the fear that the discomfort will never go away. Like everyone with OCD, Kevin quickly learned that his compulsions eventually would get him to the point of feeling better, at least some of the time. The problem was that they were time consuming and greatly interfered in his day-to-day functioning.
Neurological Effects
Do we know what causes OCD? The short answer is not really. However, we do have some good ideas based on research. Abnormalities in brain functioning appear to play some role. The frontal cortex and subcortical structures of the brain may be different in people with OCD than in people without it, according to the National Institute of Mental Health. Additionally, it’s widely accepted that the neurotransmitter serotonin may not be performing properly. This is why the use of selective serotonin reuptake inhibitor (SSRI) medications is the first-line treatment for OCD.
OCD is also believed to run in families. There is a 10 to 20 percent greater risk of developing the disorder if a parent or sibling already has it, according to a study published in Psychiatric Clinics of North America, which looked at the genetic aspects of OCD. Keep in mind, however, that even though the incidence of developing OCD is higher if a parent or sibling already has it, there is still a greater likelihood that someone won’t.
Heredity isn’t the only cause of OCD. Pediatric autoimmune neuropsychiatric disorder associated with streptococcus (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS) are also known causes of the disorder. Both result from infections that cause inflammation in the child’s brain. PANDAS is caused by a strep infection in children while PANS occurs as a result of other infections, such as mycoplasma, chicken pox, Lyme disease, and mononucleosis.
BY THE NUMBERS
It’s difficult to know exactly how many people have OCD, but the International OCD Foundation estimates that OCD affects approximately 1 in 100 adults and 1 in 200 children. That translates to about 2 to 3 million adults and 500,000 children. The IOCDF also indicates that OCD typically occurs during one of two developmental periods, the first being between
the ages of 8 and 12, and the other being from the late teenage years to the early twenties. OCD can first occur earlier in childhood and later in adulthood, though instances of such are not as common. These numbers clearly demonstrate that OCD is not the rare disorder it was once believed to be.
For children who have either PANDAS or PANS, it’s believed that the OCD develops quickly. If you are concerned that your child’s OCD may be a result of either, it is recommended that you consult with your pediatrician or a child psychiatrist, as thorough medical testing is needed to assess for the presence of either condition. Trauma may play some role as well, according to a 2007 study published in Behaviour Research and Therapy, although I’ve seen very few cases in my practice. Stress itself doesn’t generally seem to cause OCD, though it can certainly contribute to the onset of the disorder and exacerbate symptoms in someone who already has it.
Most people reading this book likely already know how overwhelming it is to live with OCD. For some, the disorder can bring about feelings of depression or even suicide. If you are having thoughts of suicide or self-harm in any way (or any other emergent mental health issue), please stop reading this book right now and immediately seek medical attention. Go immediately to your local hospital emergency room for assistance. Your safety needs to be the first priority. This book will still be there when you return home.
Expressions of OCD
Many years ago, OCD was a little-known disorder. Today, most people now have at least some understanding of it; probably the most well-known behaviors include compulsive handwashing and checking items such as ovens and doors. Yet there are many other manifestations that are also important to recognize. As we discuss the various forms of OCD, consider the term itself: obsessive-compulsive disorder. In order for the diagnosis to be made, people need to experience unwanted thoughts and images as well as some compulsive action in response to those feelings. Before I go any further, I want to recognize that there is an obsessional form of OCD referred to as “pure O.” The theory is that some people may exhibit obsessions without showing signs of compulsive behaviors. Most specialists don’t believe this theory, but understand the reasoning behind it. I’m one of those specialists. My thought process is that just because we can’t see a compulsion, it doesn’t mean that it’s not present. As an example, let’s say someone has fears of harm coming to
a family member, and as a result they engage in repetitive praying. We can’t see that compulsion, but it certainly counts as one.
Perhaps even more confusing is when someone tries to “outsmart” the OCD. An example would be someone has a thought that they may have acted in an inappropriate sexual manner and can’t quite remember the details of what happened. They don’t truly believe that it happened, but they’re also not 100 percent sure of that. As a result, they replay the situation over and over in their mind to try to find some explanation that allows them to feel some semblance of reassurance that nothing happened. That repetitive thought reaction needs to be thought of as a compulsion. So, while I do understand the term “pure O,” I don’t think that it actually exists.
One of the most challenging aspects in treating OCD is how the disorder expresses itself; no two people have it in the exact same way. The manifestations of OCD are truly endless, but we can categorize them. I’ve already mentioned a
ON MEDICATION
Many people who have OCD will benefit from taking medication. In fact, the best treatment for most is a combination of medication and a very specific form of cognitive behavioral therapy (CBT) called ERP therapy. The latter will be discussed in great detail later in this book.
The first-line drugs used to treat OCD are usually SSRIs. This specific class of drugs works on the neurotransmitter serotonin, which is believed to play a role in the development of obsessions and compulsions. Celexa, Lexapro, Luvox, Paxil, Prozac, and Zoloft are all equally effective. As a licensed clinical social worker, I do not prescribe medication, but I am often in the position of recommending to
my patients that they see a doctor who can. This can be done by both a psychiatrist and a primary care physician.
Taking medication is a very personal decision. I know many people are reluctant to do so. Misconceptions about what medication might actually do and the belief that taking medications is a sign of weakness are typical reasons that people choose to avoid this line of treatment. I can only say that I’ve known many people who initially resisted medication then, once they started, wished the treatment had begun sooner. The relief that the medication eventually brought them was well worth it.
few—contamination, harm, and “just right” OCD. Another very common obsession revolves around doubtfulness. This often occurs when someone can’t recall if a particular action has been completed. Is a door locked? Is the oven off? Do they have their phone or keys with them? This sense of doubt often triggers the checking compulsions. It’s not usual to see someone with this type of OCD and fear turn around and drive right back so they can make sure that the front door is locked or the garage door is closed—even if they’re miles from home.
TRIGGER
TEMPORARY RELIEF
OBSESSION
COMPULSION
FIGURE 1.1 OCD episodes always begin with a trigger. Common examples are touching something believed to be dirty or simply having some intrusive, random thought about harming someone. This trigger quickly leads to obsessive thoughts. The compulsive behavior follows and frequently does serve to lessen the distress and anxiety caused by the trigger. However, relief is only temporary; another trigger will restart the cycle.
Symmetry, orderliness, and counting are also common manifestations of OCD. Symmetry and orderliness can be seen when items must be lined up in a certain way. For example, in the refrigerator all bottles and cans must be put in a way so that the labels face out, or books in a bookcase have to be organized by their height. Counting can occur with almost anything. A person must count the stairs each time they walk up and down them, or while reading they count every letter T they come across. Interestingly, the obsessional thinking associated with these types of actions can also be endless. One might assume that the usual obsession with these
OCD Cycle
types of actions may be about trying to ward off some harm or dreaded event from occurring. But it may also be the “just right” OCD, when a person feels compelled to engage in a repetitive action until they feel some sense of completion.
Before moving on, I do want to say a word about hoarding, which will not be referred to in this book in much detail. In prior editions of the DSM, OCD had been classified as an anxiety disorder. In DSM-5, a new category of OCD and Related Disorders was added, which includes body dysmorphic disorder (obsessions associated with physical appearance), trichotillomania (hair pulling disorder), excoriation (skin picking disorder), and hoarding disorder.
This change came as a result of recognizing that these disorders share many characteristics with OCD but are also different enough to warrant their own diagnosis. In hoarding, the key obsessional element is the fear of losing something believed to be of value, and the key compulsive action is the hoarding behavior itself. Treatment, though, is very different from the more classic forms of OCD. Given the new DSM-5 classification of hoarding and the differences in treatment, I felt it best to keep the focus of this book instead on OCD itself. Please refer to the Resources (page 129) in the back of this book for helpful information specific to hoarding.
How This Book Can Help
Kevin, the teenager mentioned earlier, is doing great. Sure, his obsessive thoughts still pop up, but he is able to dismiss them fairly easily. He has learned that if he disengages from his compulsions, the urge to do them will subside. He is still triggered at times enough to perform his rituals associated with light switches and doors. Sometimes when walking, he still gets an urge to have to repeat his steps. But Kevin has learned how to frustrate and confuse the OCD. With regard to his urge to walk back and forth over cracks three times and turn his head to the right, Kevin has it much more under control. Sometimes he doesn’t complete the compulsion at all, and other times he goes back only once or twice. He’s learned to turn his head to the left or not at all. All of his effort to weaken the OCD has worked. The disorder doesn’t control him much anymore. Kevin also now knows that when he resists those urges, the OCD is going to push back and try to make him feel that there is something very important about performing those compulsions. He understands that if he fights back, the OCD will eventually relent.
SPECIAL SECTION: OCD SYMPTOM CHECKLIST
Below is a list containing many of the recognized obsessions and compulsions. As you’ll see, some are well known while others you may be learning about for the first time. You may also discover that you’re struggling with some forms OCD you didn’t previously recognize. Please select those you feel you are experiencing. As you work through this book, knowing which of these you want to address will help you in deciding which type of therapeutic intervention to use.
AGGRESSIVE OBSESSIONS
Fear of harming oneself.
Fear of harming others.
Intrusive violent images.
Fear of causing harm due to your own inaction—i.e., not wiping up water found on stairs, which someone could slip on.
Fear of hitting someone/an animal while driving.
Fear of suddenly losing control and saying something offensive to someone.
Fear of writing something offensive.
CONTAMINATION OBSESSIONS
Fear of dirt, germs, bodily waste.
Fear of environmental contaminants, such as lead, asbestos, radiation, mold.
Fear of blood.
Fear of household items such as insect spray, bleach, cleaners, furniture polish.
Fear of uncooked food items; fear of salmonella, E. coli.
Fear of diseases, such as AIDS, Ebola, cancer.
Fear of animals and fear of catching rabies.
Contamination obsessions may also contribute to the development of somatic obsessions associated with illness.
RELIGIOUS OBSESSIONS
Fear of having blasphemous thoughts and doing something against one’s religious values.
Fear of screaming out blasphemous statements while in a place of worship.
Fear of being punished by God for “bad” thoughts.
Fear of using God’s name in anger.
Fear of seeing something red or the number 666.
SCRUPULOSITY
Similar to religious obsessions, but focus instead is on concerns related to morality and ethical behavior.
SEXUAL OBSESSIONS
Fear of having thoughts about children that are believed to be sexual in nature.
Experiencing sexual sensations/arousal in circumstances considered inappropriate, such as in the presence of children.
Fear of losing control and engaging in sexual behavior with children.
Similar thoughts about family members/animals.
Fear of becoming homosexual when person believes they are heterosexual (referred to as HOCD). Certainly, the opposite can be true when someone who is gay has fears of becoming heterosexual.
HOARDING AND SAVING
The essence of this obsession is the fear of losing something believed to be of value. The item(s) often may appear as useless to others.
There is no limit as to the type of items that can be hoarded, though newspapers, magazines, old clothes, and shopping bags are among the most common.
SYMMETRY AND EXACTNESS
Items have to be placed in a certain manner or direction. This could include, for example, books in a bookcase, bottles in a refrigerator, or clothing all being folded in the same way.
Need to engage in certain behaviors, such as writing, in a very specific manner.
CHECKING COMPULSIONS
Examples include doors, windows, locks, ovens, stove tops, smartphones (whether they are on or off).
Checking that you did not harm others or that you will not harm yourself.
Checking that you didn’t insult someone.
Checking for bodily sensations as indicators of illness.
Excessive checking of lists.
Checking contents in pockets, bags, purses, wallets, backpacks, etc.
Checking that items are where you believe they are supposed to be.
Checking that a mistake was not made, such as with homework.
CLEANING AND WASHING COMPULSIONS
Handwashing, excessive and/or ritualized.
Excessive and/or ritualized behaviors associated with hygiene, such as showering, bathing, brushing teeth, and wiping after toilet use.
Cleaning of inanimate objects, including smartphones.
Excessive use of hand sanitizer and wipes.
REPEATING AND COUNTING RITUALS
Often associated with walking, touching, tapping, rubbing, reading, and writing.
Almost anything can be counted: steps, words, ceiling tiles, seconds on a clock.
Rewinding TV shows, videos, DVR.
MISCELLANEOUS OBSESSIONS AND COMPULSIONS
“The need to know.” This is basically a form of checking. An example could be stopping to identify items seen while walking.
“Just right” OCD, as was discussed earlier in this chapter.
OCD Symptom Checklist, continued
Sensorimotor OCD (aka hyperawareness OCD). This occurs when someone can’t stop thinking about normal, automatic bodily sensations, such as blinking, swallowing, breathing, their heartbeat, and tongue and mouth movements. Being hyperaware of making eye contact with others, floaters in the eyes, and body movements such as arms and legs while walking all are known manifestations of this form of OCD.
Relationship OCD. This pertains to obsessional thinking over a relationship. Common thoughts often are associated with fears that the person may not truly love their partner or that the partner doesn’t really want to be with them.
Existential OCD. Examples of this may be obsessions over the meaning of life and reality.
Mental rituals, such as praying or having to say certain phrases.
Obsessive slowness. The better term is probably compulsive slowness, as this occurs when someone takes a long time to complete routine tasks, such as bathing, brushing teeth, and getting dressed.
Emotional contamination. This pertains to the fear of essentially picking up qualities of other people found to be either frightening or disturbing in some way. One example could be obsessions over becoming homeless after having seen a homeless person.
Reassurance seeking. In my opinion, this is the most common compulsion of all. Typically, reassurance seeking occurs when there is a fear of something bad happening. Examples could be the fear of harm coming to someone, doing poorly on a test, or becoming ill. If getting reassurance actually worked, people wouldn’t feel the need to do it so often.
WORKING THROUGH HARM OR SEXUAL OBSESSIONS
These types of obsessions are often the most disturbing for someone with OCD and sometimes even for their therapists. I have found this especially true for clinicians who have little experience with the disorder. All therapists are required to report cases of suspected abuse, and some may understandably worry when they hear a patient acknowledge having these types of thoughts. However, in this circumstance we’re referring to OCD, which means that the person is at little or no risk of actually causing harm. In fact, I’ve never come across someone with this type of OCD who has ever acted on their thoughts. However, with these cases, I am always careful to conduct a risk assessment. If I’ve never met someone before, I don’t know whether they would do something terrible or not but it’s not that difficult to make that assessment. Consider these questions:
1. Does the person enjoy having these thoughts? If they struggle with OCD, the obvious answer is no (they also probably wouldn’t come to see me in the first place if they did enjoy them).
2. Is the person trying to have these thoughts? Again, with OCD the answer is going to be no. This shouldn’t be confused with the compulsive mental act of trying to figure them out—that is purposeful.
3. Does the person have a prior history of acting out in this way? If the answer is no, this is probably another sign that we’re dealing with OCD. If the answer is yes, then I need to know more about those circumstances before I can be sure that the symptoms warrant an OCD diagnosis.
4. Is the person actively psychotic? If the answer is yes, then I wouldn’t treat such thoughts as OCD.
If these questions have been sufficiently addressed and it’s been determined that these thoughts, images, and urges are OCD related, then it’s time to work toward exposure therapy. I’ve seen so many people with these types of obsessions over the years and haven’t found any to be at risk of causing any harm to themselves or anyone else. I can’t say with 100 percent certainty that it will never happen. But I can say that the likelihood is so low that it doesn’t warrant all the torment and life disruption that comes with it.
Now it’s your turn. What are your symptoms? How would you classify yourself? The preceding list is by no means an exhaustive one. Did you see any of your own obsessions and compulsions? If so, which ones did you identify with mostly? Did I miss any? Please write those down as well in the space below:
Both Kevin and his parents have learned that our goal was never to fully eliminate the OCD. Much research has been conducted on the disorder and continues to be, but a cure for OCD has yet to be discovered. To many, that can be very disappointing news, but it’s something people have to learn to accept at this point in time. The current goal in treating OCD is management. Life requires people to manage many things, and for some OCD is one of them.
My goal for you as you read this book is that you, too, have a similar experience to Kevin’s. OCD is determined; it doesn’t give up easily. As we go forward in this book, we will take a much deeper look at how OCD is treated, with a special emphasis on ERP. Please know that OCD may not give up easily, but ERP is equally tough. This therapy gives people the necessary tools to manage OCD. It’s not an easy process, but as you’ve likely heard before, things that are worth doing often aren’t. ERP will challenge you, frustrate you, and at times even scare you. But we’ll do it together and in ways that feel manageable and respectful. As I tell my patients, it’s never my goal to scare the daylights out of them. We’re just trying to beat the OCD into submission. As Kevin once said to me, “I know OCD is going to win sometimes, but I’m going to win more.” The ultimate goal, of course, is improving your quality of life. Kevin is doing well in high school; he can now go out with friends and participate in sports without the OCD dictating his next move. I wouldn’t have written this book if I didn’t feel the same could be true for people who choose to read it.
Wrap-Up
We’ve covered a lot so far in this first chapter. You’ve gotten to know Kevin and his struggles as well as his successes in dealing with OCD. You’ve learned about the DSM-5 and possible causes for the disorder. Additionally, we’ve described the many forms OCD can take and introduced treatment options, especially medication and ERP. There’s so much more to come. As was mentioned earlier, the focus will be on helping you develop a treatment plan as we move forward. As you have seen both from this book and from your own personal experiences, OCD is very creative. People often ask me if I’ve ever heard of their form of OCD. Usually the answer is yes, but sometimes I hear about obsessions and compulsions I’ve never encountered before. What’s important to know is that it doesn’t matter. Sure, I need to know as much as I can to develop an effective plan, but truth be told, all forms of OCD are unusual. That’s the nature of the disorder.
What’s important is that we stick to what works and think carefully about how to apply the exposure therapy protocol to fit your specific needs. As creative as OCD is, we need to be even more creative.
I encourage you to check in with yourself after each chapter. Assess how you’re feeling and what you’ve learned. Of course, reading a book like this isn’t like reading a novel. Take some time to think about what you’ve read, and go back to parts that you feel you need to review more. This is a lot of information to take in.
So, how’s this going for you so far? Do you feel that you’ve learned anything new? About yourself? About OCD? Have you identified areas you feel you need to work on more? As we move forward to focus on treatment, what are you looking forward to? Are you worried or frightened? That’s normal and to be expected. Please, make note of that, too.
CHAPTER TWO
Therapeutic Approaches
UNLIKE SOME OTHER PSYCHIATRIC PROBLEMS, there is little debate as to which approaches are most effective for OCD. The treatment of choice is typically CBT. But that concept is really too broad of a term to truly describe the recommended approach for OCD. Imaginal exposure and ERP are forms of behavioral therapy, but they offer more specifically defined treatment. ACT and mindfulness can also be used, though more often they are considered adjunct approaches that can provide some relief. All will be described here.
Primary Treatment Methods
According to the International OCD Foundation, once someone begins showing symptoms of OCD, it takes an average of 14 to 17 years before they receive appropriate treatment. With all that is known about OCD at this point, how can that still be possible? One reason may be due to a critical shortage of clinicians skilled in assessing and treating OCD. I believe many patients wind up getting misdiagnosed and/or receiving ineffective treatment.
This may seem odd, but if you have to have OCD, there’s never been a better time to have it. In recent years, research and advances in medications and therapy have made great strides in treating the disorder. A diagnosis of OCD today means there is a far greater likelihood of getting better than ever before.
Cognitive Behavioral Therapy
The essence of CBT is really what the term itself implies. The cognitive piece is about building awareness of your distorted negative thinking patterns, and the behavioral part is about confronting the maladaptive coping strategies by utilizing a variety of very specific techniques. Keep in mind that distorted thinking patterns are not unique to OCD. We all experience such thoughts regardless of whether we have a psychiatric problem or not. The power of the cognitive therapy part of CBT lies in learning to think from a more rational perspective and developing more effective ways to diminish your distress.
Exposure and Response Prevention Therapy
A 2015 report published in Psychiatry Research on the efficacy of CBT for treating OCD stated that “in light of the abundance of evidence supporting the application of ERP, this treatment should be predominant in first-line evidence-based psychological interventions for OCD.”
If you have a phobia of elevators, the best treatment is to get in an elevator. The same thinking applies to treating OCD. If you’re fearful of germs and engage in all sorts of compulsive acts to avoid contact with them, your therapy plan is going to include exposure to situations that frighten you. This could mean touching doorknobs with bare hands, or perhaps shaking hands with someone with whom you might ordinarily avoid contact. There are many examples of this when it comes to OCD therapy.
As I mentioned in chapter 1, ERP is conducted in a step-by-step manner to increase your chances of success and to build your confidence. If you have a phobia of elevators, the first exposure wouldn’t be to get in an elevator and go up 20 floors. Instead you might be assigned first to get in the elevator and walk out before the door even closes. Once your anxiety associated with that sufficiently subsides, you would then move on to subsequent items on your hierarchy and continue doing that until you eventually get to the point of being able to go up to the twentieth floor. The same incremental approach is used for OCD.
But with ERP, it’s not enough to be exposed to your fears. The therapy also calls for a response prevention plan after the exposure. This means not performing the related compulsive behavior associated with the obsession. Maybe you’ve taken that first step and touched something you believe to be contaminated; now you need to stop the compulsion that drives you to clean your hands afterward. If you’re working on checking behaviors associated with the stove top, you must start to resist the compulsion to check the burners. If you’re doing exposure work but not also doing the response prevention, then you’re not really engaging in ERP.
Imaginal Exposure
Imaginal exposure is another form of ERP therapy, but instead of real-life situations it uses imagery. This is a wonderfully effective technique for many forms of OCD, especially for those wherein real-life exposure may be especially difficult, impractical, or even inappropriate. A good example is if someone has fears of losing control at an airport and screaming, “I have a gun!” For such an obsessive thought, I might write a story, usually referred to as an exposure script, that involves this very event occurring. The person then reads the story over and over again or perhaps records and then listens to it repeatedly until the anxiety and fear subside. This can be a very powerful technique, provided that the script itself produces enough anxiety to make the exposure worthwhile. We will review this technique in much more detail later.
Digging In to CBT
Here’s a situation most of us have been in at least once in our lives: Let’s say you’re about to be interviewed for a job, and you’re sitting patiently in the waiting room. You look up and see the door to the interview room open; the supervisor
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time to make their charge. They accordingly rushed into the street, and were face to face with the students.
‘Trapped!’ ejaculated Theria, as he felt his progress stopped, and saw the tumult below. ‘Oh, Master Blacquart, you shall pay for this.’
A terrible riot ensued. What the students wanted in numbers, they made up in strength and daring. They wrested the partisans from their opponents to turn against them, and in all probability would have come off the conquerors, had not Maître Picard opened one of his upper windows and discharged a blunderbus therefrom—not to injure his enemies, but to give the alarm by the report of this novel weapon, not long imported from Holland.9 It had the desired effect, and in a few minutes brought back the Guet Royal.
Some of the students fled at once as they saw the night-patrol advance, for they were men with whom there was no trifling. Those who remained, being a small number, were now captured by the bourgeois; and then Maître Picard emerged from his house, and Theria was let down and seized.
‘Huzza!’ cried the little chapelier, giving way to fresh antics. ‘We have caught you—eh? Take him away; to the guard-house with such a brawler. Stop—no—the glory shall be with me. Gentlemen of the Guet Royal, march on with your other prisoners; the Garde Bourgeois will take charge of the ringleader. Mauvais sujet—ugh!’
Camille took no notice of Maître Picard’s address. He was, however, chafing with anger inwardly at being thus caught.
‘To the guard-house!’ continued Maître Picard, ‘without loss of time. I have rid Paris of a brigand—a cut-purse. En avant!’
Drawing his sword as well as his short arms and fat little body permitted, Maître Picard placed himself before the prisoner, and two of the others followed. In this state they started off, the hatter leaving Blacquart in charge of his shop, and proceeded towards the nearest corps du garde. But, as they were passing down the Rue de la Harpe, Camille, who had been watching his opportunity, suddenly tripped up the chapelier, and sent him rolling into the kennel that rushed down the middle of the street, before he had time to save himself. He then as rapidly dealt a couple of heavy blows to his followers, and whilst they were aghast at the unexpected attack, rushed down the Rue du Foin, in the obscurity of which he was
immediately lost. But we must follow him along it, leaving the two guards, first to recover themselves and then to pick up Maître Picard, in as sorry a plight as might well be.
Flying along the narrow thoroughfare, a few minutes brought Camille to his abode in the Place Maubert. He went directly to the apartment of Philippe Glazer, who was at home, and briefly told him what had happened.
‘It will not stop here,’ said Theria. ‘That wretched bourgeois can make a nasty business of it if he likes, and I must leave Paris at once.’
‘Immediately?’ asked Glazer.
‘Directly. My studies, such as they have been, are nearly finished, and Liège will do for me to settle at as well as anywhere else. Besides, it is my home.’
‘Can I assist you in anything?’ asked Philippe.
‘In one thing only—a little money, for I am quite cleaned out by mes camarades. In return, Philippe, I leave you everything—my books, my rapier, and my Estelle—poor Estelle! Don’t ever part with my rapier whatever you do.’
Glazer smiled at his friend’s speech, as he collected what little money he had by him, and gave to the other.
‘Ten thousand thanks, Philippe,’ said Camille, ‘it shall be repaid some day; we do not cheat one another.’
‘I will trust you,’ said Glazer; ‘is there anything else I can do for you?’
‘One thing,’ said Camille, more seriously. ‘I am not one to boast of favours bestowed, or even hint at them, but you will find a packet of love-letters in my old escriban. Burn them all—they are from Madame de Brinvilliers.’
Glazer uttered an exclamation of mingled incredulity and surprise.
‘It is true,’ said Camille; ‘she wrote them to me, telling me that I was the only one she ever loved—that all the other attachments had been madness—folly Pshaw! each avowal was stereotyped, and did for others as well as it will again do for the next. Burn them all. Adieu! and tell Estelle to console herself.’
And, warmly shaking his friend by the hand, Theria flew down stairs, leaving Glazer almost bewildered at the rapidity of the
interview and the avowal he had just heard.
CHAPTER XII.
EXILI SPREADS THE SNARE FOR SAINTE-CROIX, WHO FALLS INTO IT
T tower of the Bastille, which the Under-Governor had designated as the Tour du Nord upon Sainte-Croix’s arrival, was generally known as the Tour de la Liberté, which title, from the mockery of the appellation, was not in frequent use. The Bastille, it may be known, consisted at that time of eight towers. Two of these—the Tour du Trésor, so called because it was chosen as the depot of the wealth amassed by the sagacious Sully for Henry IV., and the Tour de la Chapelle, were the most ancient, and had formerly been merely the towers which flanked the entrance to Paris by the Faubourg St. Antoine. Subsequently the Tour de la Liberté and the Tour de la Bertandière were added opposite to those just spoken of—the latter being the one chosen, some centuries afterwards, as the prison of the unfortunate ‘Man in the Iron Mask.’ The Tour de la Liberté was at this early period the most northern elevation—hence its second name; and the entrance to the city lay between those four towers, on the spot where the huge cast of the elephant, intended for the fountain, may be recollected by the visitor on the way to Père la Chaise. To those four towers Charles VI. added four others; about 1383 chambers were hewn in the thickness of the wall between them, drawbridges were erected, a fosse dug around, and the Bastille was completed.
All these towers contained the cells for the prisoners; and as a portion of our story must now necessarily pass in the Bastille, we will call the attention of the reader to them; but briefly as possible. In each tower were five ranges of cells. The lowest of these, or cachots, 10 were the most horrible, receiving what little light they had from the lower part of the fosse. The floor was covered with a nauseous slime, perpetually oozing from the low grounds around, and laden with rank and poisonous exhalations. Here noisome reptiles—the toad, the lizard, and the rat, had their homes— sweltering and crawling on the damp floor; from which the only
refuge allowed to the wretched prisoner was a species of bed, formed by iron bars projecting from the wall, a few inches above the ground. In many of these sinks, still greater misery was contrived for the occupant. The lower part was a mere well, cut out in the form of an inverted sugar-loaf, in which the prisoner was compelled to exist, so that the feet found no level resting-place, nor could the body repose.
Next in order of the chambres rigoureuses, were the iron cages. They were above the cachots, and were formed of small beams of wood plated with iron, being about six feet square. The next were termed the calottes. These chambers were the highest, being built in the summit of the towers, and so contrived that the prisoner could only stand upright exactly in the middle, and there was scarcely space in them for the length of a bed, although the depth of the loopholes was ten feet, being the thickness of the wall. These were small, admitting very little light, which was farther excluded by two ranges of thick iron bars, within and without. Being close to the roof, the heat of the sun in summer was insupportable, converting them almost into ovens; in winter the cold was equally terrible, since there was little space for a fire. In these rooms the victims were usually confined who were destined for the oubliettes—the wheels armed with cutting points, which, turning round, drew the sufferer between them and cut or tore him to pieces.
The intermediate chambers were somewhat more comfortable. They were fourteen or fifteen feet high; and, although the windows were heavily barred and counter-barred, were tolerably well lighted; whilst, from some of them, views could be obtained of the boulevards and various parts of the city. The rooms were generally numbered, and named after the towers in which they were situated. The one that Gaudin de Sainte-Croix now entered was the Onzième Liberté—and by the same title was the occupant known during his sojourn in the prison.
The recognition, both on the part of Gaudin and Exili, was instantaneous, and an expression of surprise burst from the lips of the former as he discovered the falcon countenance of the physician. But he directly recovered his composure, recollecting that the gaoler was still in the room, and remained silent until Galouchet departed,
closing after him, one upon another, the three massy doors which, covered with heavy locks, bolts, and iron studs, guarded each of the chambers.
The first impression of Exili had been that some new punishment was in store for him, upon seeing his late enemy enter, accompanied by the functionary. But as the man left, and Gaudin, dashing his hat upon the ground, threw himself in an old fauteuil at the foot of the pallet destined for him, he perceived that he also was a prisoner. A savage gleam of triumph passed across his livid countenance as he bade Sainte-Croix welcome in a tone of mockery
‘My prophecy has been speedily fulfilled,’ said Exili; ‘I gave you six months—little more than thrice six hours have passed, and we meet again. You may find good reason now to burn me as a sorcerer, when you wish entirely to get rid of me.’
Gaudin smarted under the taunt; but his face betokened no trace of the annoyance. He took the empty sheath of his sword, which still hung at his side, and, smiling carelessly, played with the lace that was fixed round his boot.
‘It is an odd rencontre,’ he said; ‘but you are no sorcerer, or you would not have been here. On that score you are safe. We stand a chance of being together for some time—perhaps we may become better friends.’
‘Friends!’ replied Exili, with a short, dreary laugh. ‘Never: we are not made of the stuff that can harbour such a dull sentiment. Crime —purpose—common interest—might set up some tie between us; but not friendship.’
‘I care not what you call it,’ said Gaudin; ‘our battle has become a drawn game, and we must make the best of it. Yesterday I had my revenge—to-night your turn has arrived. On the score of vengeance, then, we are quits. At least towards each other,’ he added, after a moment’s pause.
Exili had never taken his eyes from Sainte-Croix since he entered; his piercing glance appeared to be scanning the thoughts that prompted every word the other uttered. Gaudin’s last speech appeared to have awakened fresh attention.
‘And to no one else?’ asked Exili emphatically, still looking fixedly at him. ‘May I ask through whom you were sent here?’
‘Through the cause of all that can most wring and crush us, either in this world or that which is to follow, for aught I know.’
‘A woman?’
‘Your divination is again right.’
‘And that woman is the Marchioness of Brinvilliers.’
‘I mentioned no name,’ said Sainte-Croix quickly.
‘You did not,’ replied Exili; ‘and yet I knew it. You cannot suppose that I should remain ignorant of what has been the gossip of the shops and carrefours of Paris throughout many a fine spring afternoon this year.’
‘Her husband never knew it,’ said Sainte-Croix, for the minute thrown off his guard, and admitting the truth of what had been a random venture on the part of Exili.
‘In such case the husband is always the last,’ returned the physician, ‘to credit his own dishonour. And yet it was not Antoine Gobelin who sent you here.’
‘You are right once more,’ said Gaudin. ‘It was M. d’Aubray, the lieutenant-civil, her father. Curses wither him!’
The features of Exili assumed an expression that was perfectly fiendish, as he gazed upon Sainte-Croix, who was divesting himself of his garments, and flinging them carelessly about the room here and there, before lying down upon the truckle-bed. Not wishing to extinguish the lamp, yet disliking the glare in his eyes, he had removed it to the chimney-corner, near which was placed a rude table.
‘It is cold!’ he said, as he endeavoured to warm his hands before the dying embers.
‘So I thought last night,’ said Exili; ‘but I am already inured to it. It is, however, a different change for you, from the Hôtel d’Aubray. I am used to strange apartments; and I have no lady-love who may play me false during my imprisonment.’
A spasmodic tremor passed through Sainte-Croix’s frame; his hands were clenched and his lip quivered. The convulsion was slight and rapid, but it was observed by Exili. He went on.
‘It is annoying, too, to dream that others may share her affections whilst you are imprisoned here. Her years are but few—her blood is
young and vivid. The Marquis, too, neglects her—so goes report in Paris—and she must have some one to attach herself to.’
‘No more!—no more!’ cried Gaudin, with a sudden and violent outburst of passion. ‘Fiend! demon! what drives you thus to madden me?’
‘These are harsh terms to christen me by,’ returned Exili, with a ghastly smile; ‘especially when it is in my power to place in your possession what you now desire above anything else the world could bestow.’
‘And what is that?’ asked Gaudin, assuming an indifference through his anger.
‘Vengeance!’ returned Exili, as he raised himself on the pallet, and glared upon Sainte-Croix like a basilisk.
A scornful expression of contempt was Gaudin’s only reply.
But Exili saw that his prey was coquetting with the bait. He continued—
‘There are dull moralists and fools who will tell you that revenge is an ignoble passion, fitted only to those grovelling spirits who dare not resent an injury, and yet are too sharply stung to pass it over. Believe them not; it is a glorious triumph of retribution, although the success of the cast will alone decide whether it will be called justice or cowardice by the world. You are indebted for your present position to Dreux d’Aubray; you burn for vengeance. If you fail the world will call you pitiful, mean, lâche: succeed, and you become a hero. Suppose I make that success certain!’
‘Pshaw! you are leading me on to some new toil,’ said Gaudin. ‘We are powerless here; were we otherwise, I should mistrust you. This is no place for bandying smooth phrases; nor are our relations towards each other such as require them. You know my sentiments towards you.’ Then, after a moment’s pause, he added, ‘What plan do you propose?’
‘As I expected,’ thought Exili; ‘his curiosity is aroused.’ ‘It is full late,’ he continued aloud, as the sound of the bell vibrated through the building from the Tour de la Chapelle. ‘To-morrow your excitement will have somewhat abated, and all will be explained. Doubtless your couch will prove a trifle harder than the one you have
been accustomed to. Good-night; and may she visit you in your dreams, for you will have little chance here of seeing her otherwise.’
And with this last observation, which had the full effect he intended, the physician turned on his pallet and was soon asleep, or affected to be so.
But it was long before Gaudin slumbered. The events of the evening were in themselves enough to drive anything from his mind, and the last conversation with Exili had added fresh wrath to the mingled blaze of anger, jealousy, and impotent desire of revenge that consumed him. At last the objects in the room imperceptibly faded from his sight, or merged into the strange forms which his halfslumbering senses conjured up; and in this state he lay for upwards of an hour, with a consciousness of existence, but motionless and silent.
Suddenly he awoke—if it could be called awaking from a state that was scarcely a sleep—and cast his eyes across the room towards the bed of his companion. Exili was awake as well. He had raised himself in bed, and, by the light of the lamp which still burned in the chimney-corner, was staring fixedly at Sainte-Croix, with the same riveting gaze he had before directed towards him. It was not the look of human intent—a serpent would have fascinated a bird with the same expression, until the victim fell into its yawning mouth. Gaudin quailed before it—he knew not why; but there was something terrible in the unclosed and glaring eyes of the physician, which almost precluded him from inquiring what he desired.
‘You need not be alarmed,’ replied Exili, in an unconcerned tone. ‘Whatever my wishes might have been towards you yesternight, at all events, you are safe here. I was attracted by that curious bauble hanging round your neck. Where did you get it?’
He directed Sainte-Croix’s attention to a small gold heart, about the size of a walnut, which hung round his neck, and which he had not laid aside in divesting himself of his clothes for the night.
‘It is an amulet,’ said Gaudin, ‘and contains a charm against an evil eye. I have heard it will also yield visions of the future. I never put it on one side.’
As he spoke, he opened the heart in its centre, and took out a crystal of a reddish colour, set in a circle of silver. Exili gazed at it still
more earnestly than before.
‘It is a beryl!’ he exclaimed.
‘Eyes less piercing than yours might tell that,’ replied Sainte-Croix. ‘Your fool affected to expose one for sale on the Carrefour du Châtelet but a short time since.’
‘I will tell you more,’ continued Exili, still fixing his scrutinising gaze upon the amulet. ‘The names of the four angels are graven round it: they come in order thus—Uriel, Raphael, Michael, Gabriel. I have seen that stone before. Where did you get it?’
‘It matters little to you,’ replied Gaudin; ‘suffice it to say it is my own.’
‘And you did not read your arrest on its surface?’
‘I have kept it merely as a charm,’ answered Gaudin.
‘Then you have abused its power,’ continued Exili. ‘Listen! do you hear the night wind howling round the towers of the Bastille and rushing down the chimney of our apartment? To common ears it is but the wind—a viewless thing that comes and goes, hurrying on around the world until its force is spent and it dies in nothingness. To me it is far otherwise,’ he continued, as his eyes blazed with unwonted fire, and he raised his arm on high. ‘Each gust is laden with the wrath of some damned spirit waiting to be called upon to make that beryl a mirror of the future, and you neglect the appeal. Give me the stone, and let me read the fate you care not to know.’
Gaudin gazed at Exili with fixed astonishment. The physician extended his hand, and the other took the amulet from his neck and gave it to him.
‘It is the same!’ exclaimed Exili with a smothered exclamation of surprise, as he again looked intently at Gaudin. Then, fixing his eye on the stone, he continued—
‘Its surface is dull. I can see forms moving on it, but they are indistinct, and dance from before my sight like motes, all except your own, and that remains. You may yet triumph.’
Gaudin was awed by the manner of Exili; at another time he would have laughed his predictions to scorn, but the circumstances, the hour, and the place, combined to make him think very seriously of his companion’s remarks.
‘What do you mean?’ he asked.
‘I will reply by putting another question,’ said Exili; ‘where did you get this mineral?’
‘I have had it many years; let that suffice. Now, I claim to know the import of your speech.’
‘You may yet triumph,’ repeated the Italian; ‘and by my means alone. I am not, you see, the enemy you thought me. Again, I say, wait until to-morrow.’
‘Nay, to-night,’ exclaimed Sainte-Croix. ‘I beseech you tell me what you mean.’
‘The charm may be broken,’ continued the other; ‘it is not yet time.’
The manner of the physician had worked upon Sainte-Croix’s curiosity strangely. He again implored to know what the other alluded to.
‘To-night—now—this instant!’ he exclaimed.
‘I will gratify you,’ replied Exili. ‘To-morrow they will bring me my chemical glasses from the boat-mill, together with such dull elements as the ground yields—simple and harmless—in order, as they suppose, that I may practise alchemy. Fools! they little know the change that paltry lamp can work in innocuous earths.’
‘What do you propose to do?’ asked Sainte-Croix.
‘To put you in possession of all I know myself,’ continued Exili, ‘and bring Marie de Brinvilliers once more near you, unquestioned, undisturbed. Seek no further. The life and death of those you love or hate shall be alike within your grasp. The destroying angel shall become your slave, and go abroad, obedient to your will alone. Your bosom should now harbour but one thought—and that must be revenge.’
Exili threw back the amulet to Sainte-Croix, and sank back on his pillow; whilst Gaudin, finding he returned no reply to his questions, once more sought to fly from himself, and the black thoughts that haunted him, in sleep.
CHAPTER XIII.
GAUDIN LEARNS STRANGE SECRETS IN THE BASTILLE
I was not until Galouchet, the gaoler, entered the chamber of the Tour de la Liberté the next morning that Sainte-Croix awoke from his slumbers—from one of those bright dreams of freedom, triumph, and happiness, albeit always tempered with some vague mistrust, which haunt our sleeping existence; the fairer in their visioned prospects, the more gloomy and hopeless the reality.
Exili had already risen. He was looking over the contents of a small chest of carved wood, placed on the table before him. The gaoler was apparently making preparations for breakfast, clattering some metal plates upon the undraped and rude table; and in the fireplace the dense smoke was creeping through some hissing pieces of damp wood, as the sap sputtered and bubbled from their ends. Gaudin stared about him confusedly The last impression of his dreams was mingled with his waking sensations, and he remained silent for a few moments, after some incoherent words, to collect his senses. Exili muttered some conventional salute, and then went on with his scrutiny, whilst Galouchet, having put the table in order, according to his own notions, offered his assistance towards completing Sainte-Croix’s toilet.
‘What charge will monsieur choose to defray for his nourishment?’ asked the gaoler, as Gaudin rose from his pallet.
‘What do you expect?’ inquired Sainte-Croix.
‘Parbleu! we have all prices. You may live like a prince for fifty livres a-day, or starve like a valet for two. This will include your washing, if you are not over-fond of clean linen, and a candle anight. The firewood you must pay for separately.’
Gaudin looked towards the fireplace, and the struggling flame.
‘Ah!’ said Galouchet, divining his thoughts; ‘the wood is rather damp, to be sure, but that makes it last the longer; and as you and Monsieur Exili occupy the same room, it will come cheaper.’
‘Is there news in the city this morning, Galouchet?’ asked Exili.
‘But little,’ returned the functionary ‘Pierre, the scullion, sleeps out of the fortress, and tells me that an eboulement took place last night, and the Bièvre burst into some of the carrières of St. Marcel; and fell so rapidly, in consequence, that all the mills this side of St. Medard were stopped for three hours.’
‘Was anybody lost?’ inquired the physician.
‘It is believed so. A party of Bras d’Acier’s gang were hunted out of the vaults between the Cordelières and Montrouge, like rats in our cachots, when the rains come; and one of the superintendents at the Gobelins was fished up, half-drowned, from a shaft in the Rue Mouffetard.’
‘Do you know his name?’ asked Sainte-Croix eagerly.
‘I can’t say I do,’ returned Galouchet. ‘What rate will you fix your nourriture at, monsieur?’ he continued.
‘I care not,’ said Gaudin; ‘only let it be something that I can eat.’
The day passed on, but the hours lagged so tediously that Time himself appeared to be a prisoner. Little conversation passed between the two inmates of the cell. Exili was occupied in writing nearly the whole day; and Gaudin, who could ill bear the confinement, with his restless and excitable spirit, after the hour’s exercise in the great court allowed to all the prisoners, obtained permission to walk on the ramparts in front of the sentinels. This position commanded a view along the Rue St. Antoine, as well as of the houses in the Rue St. Paul. Towards this point were Gaudin’s eyes constantly directed. He beheld people moving in the streets, and over the plains in the immediate vicinity of the city walls—the coup d’œil was alive with commerce—and the buzz of their voices plainly reached his ear; but he envied them not, nor drew one comparison between their freedom and his state of durance, except when he saw them turn from the great thoroughfare into the small street wherein the Hôtel d’Aubray was situated. He fancied he could pick out the pointed roof of the mansion from amongst the others, and once he imagined that he saw the delicate figure of the Marchioness emerge from the Rue St. Paul, and pass towards the city, without so much as throwing back a glance towards the fortress in which she knew he was confined. And then the hell of jealousy raged in his veins, and he felt the bitterness of captivity. He thought
of the circumstances under which he had found her with Theria the preceding evening; then came back the recollection of the impassioned interview, and her apparent devotion to him, until the struggle of his conflicting feelings to establish what he hoped for, over what he dreaded, nearly maddened him.
At length it got dusk, and he could see no more. The murmur of the peopled city died away; the lights appeared in the embrasures of the Bastille, and the night-wind chilled him. He descended once more to his cell, and found his gaoler there.
‘I was coming to seek you, monsieur,’ he said, ‘for the curfew will soon ring. Mass! your supper is nearly cold. Here is a slice of rôti, a plate of eggs, and a salad; you could not fare better at home.’
‘Have any of my things come?’ asked Gaudin.
‘They are being overlooked in the corps du garde,’ replied the man. ‘By the way, monsieur, my sweetheart, Françoise Roussel, gave me this note for you, when I met her without the walls this afternoon. She did not care that it should be read by the governor.’
Gaudin snatched the note, and discerned the handwriting of the Marchioness. Hastily tearing it open, he read—
‘Be true and patient; all may yet be well, and you will be revenged. Rely on me to aid you; we have gone too far to retract. In life, and after it, yours only, ‘M .’
‘I must put out your light,’ said Galouchet. ‘Last night you were brought in late, and nothing was said; but neither fire nor lamp can be allowed between curfew and sunrise.’
‘You can have it, my good fellow,’ said Gaudin, still quivering with the emotion which the letter had called up. ‘Here—here is some money for you. I will keep your secret. You may retire.’
The man raked out the embers on the grate, and departed. As soon as the clanking of the three doors that shut in the cell had ceased, Exili, who till now had remained quiet, arose from his table, and approaching Sainte-Croix in the darkness, said rapidly—
‘I will now show you some of the mysteries by which my career has, up to yesterday, thriven. But, first—precaution!’
He took his cloak, and by the aid of the forks on the table fixed it so that it covered the window, the position of which could be plainly ascertained by the faint moonlight from without, and then he returned towards the table at which he had been sitting.
‘The clods without think that our light and darkness is subservient to their will alone; but the elements obey not such idiots. The ether which percolates all things—vitalised and inorganic—setting up a communion between them, reveals not itself to the uninitiated. With me, the various elements are as abject slaves, whom I can summons at my bidding.’
As he spoke, he dashed a small rod he held against the wall, and a flame, so bright that Gaudin could hardly look upon it, burst from its extremity. In another moment he had relighted the lamp, and he then shook the blaze amongst the embers on the hearth, which were presently rekindled. Sainte-Croix looked upon his companion with the gaze of one bewildered. Exili read the expression of the other’s features and continued, perceiving his advantage—
‘Life and death are equally within my grasp. Whom shall I call up? Will you see the ghastly corpse of the Croce Bianca, at Milan?’
‘No! No!’ cried Gaudin, covering his eyes with his hand, as if he dreaded to meet the horrid sight.
‘Will that serve to recall its memory as well?’ asked Exili, throwing a phial upon the table.
A glance sufficed to show its nature to Sainte-Croix. It was a small bottle of the terrible Aqua Tofana—the ‘Manna of St. Nicholas de Barri.’
‘That menstruum is powerless, compared to what I am about to show you. But first, look here.’
He stooped beneath the table, and pulled out a species of cage, in which several rats were huddled together, fighting, and scrambling over their fellows.
‘Where did you get those vermin from?’ inquired Gaudin.
‘There are more in the Bastille than are wanted,’ replied Exili. ‘They have been willingly granted by some poor wretch at the base of our tower. Galouchet bought them. I told him they were to study anatomy from.’
He plunged his hand fearlessly amongst them, and drew forth one of the shrieking animals. Then squeezing its throat, he poured a drop or two of the fluid down the mouth. The rat gave a few convulsive throes, and he threw it down, dead, upon the table.
‘You see the effect of the potion,’ he continued. ‘Now, look here.’
Pouring the greater part of the remaining liquid of the phial into a glass, he coolly drank it off before Gaudin could arrest his hand. But no effect supervened. Instead of falling lifeless as Sainte-Croix had anticipated, Exili gazed at him, and, with a short, hollow laugh, threw the empty bottle amongst the embers.
‘Are you man or demon?’ asked Gaudin, scarcely trusting to his senses.
‘Neither,’ said Exili. ‘I have lost the sympathies of the former; the latter I may be hereafter. I have studied poisons, as you see; but I have also studied their antidotes. Have you kept the small phial by you, which you bought of me at Milan?’
‘It has never been out of my keeping until now,’ said Gaudin.
‘With that you could command twenty lives,’ said Exili; ‘and yet my remedies could so blunt and weaken its malignity that I would take it all at one draught. You shall learn more. Attend!’
From his box of carved wood he drew forth a series of test glasses, and half-filled them with water from the prison cruche. He next took a small flacon, and pinched a few atoms of the powder it contained into the first glass, varying the addition in each. Then dropping some colourless fluid into them, one after the other, a precipitate fell down in all, in clouds of the brightest tints, but each different.
‘See how completely these dull minerals do my bidding,’ he exclaimed. ‘To you the potion offers no trace by which its nature could be told; to me there is not an atom suspended in it, in its invisible but imperishable form, which cannot be reproduced before our eyes. Do you believe in me?’
‘I do—I do,’ returned Gaudin. ‘What price do you put upon the revelation of these mysteries?’
‘Nothing—beyond your attention and secrecy.’
‘And yet you love revenge,’ said Sainte-Croix, eyeing him with mistrust.
‘It is my life—my very blood,’ answered Exili. ‘And my revenge— the deepest I can have—is to teach you all I know.’
‘What do you mean?’
‘Simply what I have said. You may call it good for evil if you choose, but still it is my revenge. You have time and leisure before you. Make the best of both.’
Again Exili gazed at Sainte-Croix with the expression of a vulture hovering about its prey, as Gaudin advanced to the table, and, with some curiosity, handled the apparatus which was spread about it. The physician opened a drawer in the box, which was apparently filled with sand. This, however, was but on a false top, which he drew away, and discovered several small bottles, of the size of one’s finger, which he took out.
‘These small messengers have worked great events in their time,’ he said. ‘This,’ taking up one, ‘was the terror of Rome, of Verona, and Milan. I could add much to the records of the Scaliger and Borromeo families, respecting its efficacy. This,’ he added, pointing to another, ‘is so potent that a century and a half has not impaired its power. It is the foam of a dying boar, slain by poison, collected as you see, and was the scourge with which the Borgias swept away their enemies.’
‘Why is one of the phials gilt?’ asked Gaudin.
‘Because its contents are the most precious,’ returned Exili. ‘Its power baffled even the attempts at imitation of Spara and Tofana. It was discovered by a monk in a convent at Palermo, and the secret has remained with me alone.’
‘It is clear as water,’ observed Gaudin, holding it against the light.
‘And like water, without taste or odour. It aided many whose hearts clung to one another,’ he continued, watching Sainte-Croix with his eagle eyes; ‘by clearing away the obstacles that impeded their union.’
Gaudin stretched out his hand, trembling with emotion, and clutched the phial, which he regarded intently, his dilated pupil, parted lips, and short, hurried breathing, showing the conflict of passions that was going on within him. Exili passed a few more of the phials in review before him. From one he let fall a few drops upon the hearth; it hissed and boiled, and the stone remained black
where it had been; into another he dipped a piece of gold, and its yellow and polished surface was changed to a dull gray by the contact.
Then throwing out several of the allusions which he found had most deeply stung his companion the night before, he placed himself by the side of Gaudin, and proceeded to explain to him the rough composition of the different articles the box contained. And as he saw the intense attention, the almost gasping eagerness with which Sainte-Croix followed his instructions, he exclaimed almost unconsciously, ‘Mine—mine for ever!’
CHAPTER XIV.
THE CHATEAU IN THE COUNTRY THE MEETING LE PREMIER PAS
I was a dreary autumnal evening, sixteen months after the events of the last chapter, and the twilight was fast coming upon a vast forest in the province of l’Ile de France, now known as the department of the Oise. The afternoon had been chill and depressing. The wind moaned through the high branches of the trees in a dismal and monotonous wailing, and the constant rustling of the leaves as they fell to the ground showed that the season was far advanced. There were few of the wild flowers left. Two or three, here and there, in sheltered nooks, were all that remained to remind one of the past summer. The delicate heath-bell trembled in the cold breeze, as it rose amidst the dead foliage; but there were few beside. The birds were silent; the tinkling of the cattle-bells on the patches of pastureland was hushed, as the animals huddled together, shrinking from the first approach of cold; and no sound was heard to disturb the general torpidity into which nature seemed about to fall, except the echoing noise from the blows of the axe with which the peasants were cutting down the limbs of the trees for the winter store of firewood.
Yet was the Forêt de l’Aigue a pleasant place in summer, when the sunlight danced upon the turf of its long avenues, darting through the quivering foliage, and the ground was powdered with the bright petals of its flowers, from the primroses spangling its sunny banks, to the gentle violets clustering about the mossy bolls of the fantastic trees, adding their odour to the scent-laden air that swept so warmly through the branches. And during this season alone, it might have been conceived that the chateaux, which were built widely apart upon the forest, were inhabited; for the situation was indeed desolate at other times. But although the autumn was, as we have observed, far advanced, one of the largest of these country houses that a man could come to in a long day’s walk, had not yet been forsaken for the winter by its occupants. This was a large rambling building, with
many windows and turrets, surrounded by a neglected garden, with a few mutilated stone statues, corroded by the rain of many winters, and enclosed by a rude flint wall, with a broken coping. The walks were overgrown with weeds; the ponds were either dry or covered with slime and dead leaves; and water had long ceased to come from the mouths of the misshapen dolphins that formed the fountains. It was of a class of rural buildings which, in France, always appear desolate and uncared for; but this one was especially so.
In one of the large apartments of this house, a bare, uncarpeted room, which the blazing pile of firewood upon the iron ‘dogs’ of the large hearth could not render cheerful, were two persons—an elderly man and a young female. The former was seated at an escritoire, arranging a vast mass of papers bearing official seals and signatures that lay before him. His companion was plunged in a large fauteuil at the side of the fireplace, with her hands pressed against her face, as if to shut out all impressions but her own thoughts. She might have been supposed asleep, but for an occasional rapid shudder which passed through her frame, induced by the vivid recollection of some bygone scene of suffering. These two persons were M. d’Aubray, the lieutenant-civil, and his daughter, the Marchioness of Brinvilliers.
‘The wind is blowing sharply to-night, Marie,’ said the old man, as a gust of unusual violence howled round the chateau, and shook the rattling casements. ‘We must think about returning to Paris.’
‘I have no wish to go, mon père,’ replied his daughter,—‘to be pointed at as an object of pity, scorn, or curiosity. I would sooner remain here with you—for ever.’
She left the fire, and sinking on a low prie-dieu at her father’s side, took his hand in her own, and looked up in his face with a gaze of deep attachment.
‘You have nothing to fear in Paris,’ replied M. d’Aubray. ‘The court has had a thousand objects for its slander since you left; and you have been at Offemont long enough for the whole affair to be forgotten. Besides, you will return acknowledged by me, and with my countenance.’
‘Will the world believe that it is so, Monsieur?’
‘If I maintain it, they will, Marie. The dissolute life your husband is now leading at Paris—his desperate play—the orgies nightly held at
