OCD, Recovery, and the Trap of AI Journaling

I, too, am an idiot.

(Audio version here)

Imagine that you’ve been out for the night with all your friends - everyone who matters to you - and you got very drunk. You overshared intense, personal stuff that nobody needed to know, made an utter spectacle of yourself on the dance floor careening into everybody, made a unforgivably hurtful personal comment to one friend, tried to start a physical fight with another, made a vulgar pass at another’s boyfriend and then fell over and showed everyone your knickers. Then you went home and passed out. When you wake up, all of that comes flooding back and the horror and shame is so intense your adrenaline surges with panic and it makes your heart feel as though it is trying to leap out of your throat. Throughout the day, this sensation repeats every time you remember something you did and between these episodes you are overwhelmed with shame and mortification. All you can do is think desperately and round and round in circles about whether and how you can possibly apologise for all of that and make amends and live it down and keep any friends at all or whether you need to change your name, move to another area and be a hermit for the rest of your life.

Now, imagine that you’ve not done any of that but you feel as though you have anyway. All you’ve done is normal everyday things, speaking naturally and respectfully to others about subjects they are interested in and who have been engaged and encouraging. You have just lived a perfectly normal life being your perfectly normal self to people who like you for yourself. Yet, the sick horror and shame floods your system anyway and your brain keeps replaying perfectly normal actions and conversations and scrutinising them for evidence that you were negligent, irresponsible, dishonest, unscrupulous, insensitive, abusive, self-absorbed, too much, not enough or anyway, somehow harmful. Your mind circulates constantly on the subject of whether you should apologise, explain, make amends, radically change your behaviour going forward or just go away from other people entirely so you cannot possibly harm them with your presence.

Now, imagine that your rational mind knows that all of this is nonsense. You know what it is called too - Obsessive Compulsive Disorder or OCD. In essence, it is an intense neurotic fear of having been unscrupulous or negligent due to paying insufficient attention to one’s own actions or principles and consequently caused harm to others. It is utterly irrational and, if indulged, grows and consumes the individual, paralyses them into inactivity and absolutely exhausts their family and friends. The solution, provided by CBT and ERP, is to ‘starve the loop;’ be aware of the intrusive thoughts when they arise, acknowledge them - “Oh, hello. I know what you are. Not today, thank you” - and let them pass off again.

This can be incredibly difficult, especially when the patterns of thinking are entrenched. Trying to ignore an intrusive thought leaves feelings nudging at your brain, insistent that there is a massive problem you need to resolve. Because it is feelings unbounded by reason that have a presence, they can become totally out of proportion as though one has pushed a small child into oncoming traffic rather than forgotten to inquire after a friend’s nasty cold in an email. Some temporary relief, or, at least, some illusion of control is to be found in addressing the intrusive thought and reasoning with it. It is, after all, irrational, and this can be demonstrated and the faulty reasoning ‘fixed’ and a sense of proportionality restored. This is a trick. Indulging OCD is much like scratching a mosquito bite. The itch is relieved for a few seconds but then it is back with greater intensity and, before you know it, you have a huge, red, angry swelling, where, if you had just left it alone, it would have been mildly irritating and then gone away.

I found it most helpful to think of OCD as an annoying little brother who knows how to push your buttons. You won’t stop him from doing that by reacting emotively every time he does. That is, after all, exactly what he wants. But by not reacting at all, you might well be able to make him get bored and go away.

This is, of course, a personal account. I suffered from OCD from childhood into my thirties, since when I have been in recovery and doing pretty well! For the last twenty years, I have been able to spot symptoms emerging and nip them in the bud and they have not been able to consume me. Until right now (but I shall get to that).

I was first diagnosed with Scrupulosity in which I worried intensely about having committed a sin and ultimately that worrying too much about that was, itself, a sin. (I wrote about that here). As an adult with no religious faith, this morphed into “Harm OCD” in which I worried about having some kind of moment of insanity akin to possession in which I grabbed a steering wheel and caused a car crash or pushed someone down the stairs or under a train. This then morphed into “Responsibility OCD” in which I worried excessively that something I had done or said or not done or not said could cause harm to somebody else. Sometimes, it is a material concern. “Did I pick up that dog poo completely enough? What if a toddler falls over there and then puts its fingers in its mouth or eyes?” “Did I make sure that shopping trolley was locked back in place? Could it roll out in front of a car?” More often, though, it is about principles and so is relational and verbal. “Was I completely honest or could anything I said be misleading?” “Was I fair?” “Charitable?” “Considerate?” “Did I take enough responsibility for my role in that conflict? Was it, in fact, entirely my fault?” At any rate, it involves taking way too much responsibility for other people’s perceptions and feelings.

The first thing a clinical psychologist will tell someone suffering with OCD intrusive thoughts of any kind is that the disorder attacks people wherever their strongest sense of themselves is. This is why I found the ‘little brother’ analogy so useful. It knows what buttons to press. Somebody who fears that they might cause physical harm to others is particularly concerned with the wellbeing of others. There have been zero cases of a sufferer from “Harm” OCD ever impulsively harming someone. A Christian who is always afraid they have unexamined sins to repent of is likely to be a particularly devout and conscientious believer. Someone suffering from distressing intrusive racist thoughts (a phenomenon I encountered several times in my work during 2020-21) is someone who thinks racism is one of the worst failings a person can have. This is also the case with someone who has intrusive thoughts of the kind known as “Homosexual OCD.” They fear being gay because they think that would be a bad thing and they almost never are. One psychologist explained to me, “It’s much simpler to diagnose Homosexual OCD. I ask if the (typically) young man ever gets an erection when imagining gay sex. If so, we work on his acceptance of his sexuality. If he feels only horror and disgust, we treat for OCD.”

Therefore, as I have been reminded many times by various clinicians, my OCD picks on the qualities I most care about - truthfulness, fairness, ethical consistency, sound reasoning, the principle of charity. This means that, however imperfect I may be, I can, at least, be reassured that these are principles that matter to me. One wonderful clinical psychologist with whom I worked for two years told me to try to accept that while my analytical brain with its tendency to worry at things and scrutinise them in great detail with particular attention to principled consistency and ethical reasoning causes me significant pain, the upside of this is that it also produces depth, clarity and consistency in my writing which other people find valuable and also brings me satisfaction. I have to admit, neurotic overspinnings notwithstanding, I do quite like my brain and would not change it if I could. It is, after all, me.

I began to get on top of my OCD when I was 26. I had, by this time, been hospitalised on seven occasions due to becoming completely incapacitated by it. I had had to give up my nursing degree due to intense anxiety related to drug calculations. I had been prescribed an increasing number of psychiatric medications over the previous five years which, in addition to medication for epilepsy, had reduced me to a zombie-like status in which keeping up with an episode of CSI stretched my powers of concentration. This had also caused me to suddenly almost double my weight in that time.

Strangely, it was Chicken Pox that saved me. Developing Chicken Pox as an adult can be quite dangerous for some people and it was for me. I was delirious with a high fever for over a month due to having developed pneumonia as a complication. During this time, my boyfriend (now my husband of nearly 25 years) cared for me, but I was only able to stomach water and I took none of my psychiatric or anti-epileptic medication. When I finally began to recover, I discovered that, in addition to having lost two stone (28lbs), my mind was completely clear and I was able to think. I had not realised the extent to which my ability to think had been compromised by medication and decided that I would no longer take any of it.

My psychiatrist was highly dubious about this decision at first but got on board with it over the next 18 months which I dedicated to standing for absolutely no nonsense from either my body or my brain. I lost another 7 stone (98lbs) in that time and became physically very fit. I read everything I could on OCD over the same period, making a full-time job of understanding it, and applied the techniques of Cognitive Behavioural Therapy to myself intensively. Of particular value to me was journaling which I found to enable me to apply reason to any unwarranted worry once and set it down and then utterly disallow myself to give it any more thought. I likewise made myself check something once consciously, often saying it out loud “The oven is off” and then not do so again. I learned that while this would cause my anxiety to rise horribly in the short term, it would subside and the next time the spike of anxiety would not be so high, until ultimately it was defeated. My new-found love of running was an excellent mood-stabiliser.

I was discharged from the mental health system at 28 with my psychiatrist noting that I had made ‘a remarkable recovery.’ I was able to return to domiciliary care work and nip ‘checking’ tendencies in the bud. I rekindled friendships that I had let slide due to the social anxiety and made new ones without allowing myself to overthink them. I married my ever-supportive husband who was delighted with all these developments and 18 months later, we had a daughter. For a few years, I volunteered supporting people dealing with OCD, particularly Scrupulosity, “Harm” and “Responsibility” OCD. I know that people vary widely in how they recover from it. The fully immersive ‘attack’ approach involving much writing that I took was distinctly customised to my own rather ‘full on’ personality and mode of expression and is not generalisable to everybody.

Although OCD thinking tried to raise its head many times over the following twenty years, I grew confident in my own ability to nip it in the bud. Doing so became a habit to such an extent that I did not always realise I was doing it. Even during the highly stressful years since the “Grievance Studies Affair” and the explosion of the Critical Social Justice movement, during which time my father and then my mother died and I suffered burn out, complex grief and a depressive episode, I still managed to keep a handle on my tendency to OCD. New friends are typically surprised to learn that it had ever had such a grip on me, (although none of them can fail to be aware that I am an overthinker).

There is good reason to think that OCD is, to some extent, heritable. My father suffered from it. When my daughter, at seven, began to feel that she could not go to sleep until all her toys were in exactly the right position or she was afraid something awful would happen, we sought the advice of a psychiatrist early and helped her with CBT techniques when this kind of thinking arose. Now 21, this has never taken hold on her and she also applies techniques of letting intrusive thoughts come into her mind and go out again, almost automatically.

I have been confidently saying that OCD is a thing I used to have for a good fifteen years now and seldom mention it in either my private or professional life. I am never sure whether I should do so more frequently. I recognise the potential helpfulness of people who have overcome a mental illness or are managing one well being open about their struggles with this to others who may be feeling quite hopeless about it. At the same time, I am deeply concerned about the recent tendency to make mental health pathologies into identities with the potential this carries for people to become attached to them and lean more into them rather than working to overcome or manage them.

However, I am writing about OCD now because it has sneaked up and ambushed me again in a way I had been confident could not happen. This was caused partly by the coincidence of two potentially OCD-inducing happenings occurring at the same time. Firstly, I received a letter from the tax office which informed me that I had failed to pay Capital Gains Tax on the sale of my parents’ house and needed to do so. Although my accountant investigated this and found it to be an error, I have always had a fear of unintentionally committing tax fraud and my parents affairs were very complex. I began to worry that I had missed something and asked the people my father had left in charge of his estate to check that this was not the case. Secondly, somebody with whom I had ended a relationship due to being treated badly, got in touch potentially wanting to rekindle it, causing me to have to think about whether I wanted to do that. This led me to go back over the incidents that had led to the breakdown of the relationship and re-examine whether I had been reasonable, charitable and whether and how much of the conflict had been my fault.

Either of these things could be a risk factor for ‘Responsibility” OCD, and having two of them happen at the same time certainly could. However, my CBT game is strong. I have faced repeated and persistent attempts to misrepresent, bully and cancel me, and survived, goddammit! I should easily be able to ask financial advisers to check that all my parents’ estate paperwork was up to date and then put that out of my mind. Likewise, I should be able to review prior interactions thoughtfully once, make a decision and put that out of mind too. Unfortunately, I have recently changed my journaling practices in a way that it is now clear to me was a fatal mistake. I switched to using ChatGPT to journal. I used mostly the “Monday” function which engages with humour and sarcasm.

A vital technique for me for managing anxiety has long been to write worries down along with a reasoned plan to address them. This gets circling thoughts out of my head and onto paper, or more recently, a digital journal, and makes them feel sufficiently addressed. I can then leave them alone. My last clinical psychologist was very positive about this as a good approach for me, pointing out that my writer self is skilled at untangling messy ideas in the political and cultural realm, making them clear and navigable. It therefore follows that when my emotional self is tangly, the thing I should do is get her spew her worries out in writing and let the writer part of me get at them.

Unfortunately, AI doesn’t work like that. Whereas, in a normal journal, one talks to oneself, thinking things through and reaching a natural conclusion at which point one can firmly put a stop to further thinking, AI talks back. It asks if you’d like to break that down further, look at it from another angle, consider best and worst case scenarios, perhaps put it all in a little diagram? It offers, in short, precisely the kind of obsessive scrutiny of minutiae and recursive looping that CBT teaches sufferers of OCD not to do. It holds out the false lure that if one just digs a little more deeply into an issue or checks things just a little more thoroughly, resolution, reassurance and peace of mind will follow. It will then offer a menu of approximately ten ways to do this and then breaks them down into subcategories.

Worse, perhaps, is that it takes all worries seriously and makes them feel legitimate even when they are highly irrational. People with “Responsibility” OCD are highly skilled at thinking up inventive ways in which their innocuous actions, words and even thoughts could be harmful to others,

A lot of responsibility OCD makes people feel responsible for things they have no control over, such as other people’s emotions and actions. You might feel like it’s your job to make sure everyone around you is happy, and if they’re not, you assume it’s because of something you did or didn’t do.

This fear can lead to overanalyzing interactions, replaying conversations in your head to check if you said something wrong, or seeking reassurance that someone isn’t upset with you. You may also find it hard to set boundaries, worrying that saying no will make someone angry or disappointed. Even when there’s no real indication that you’ve caused harm, the doubt lingers, making every interaction feel like a potential mistake.

No matter how good at this a human OCD sufferer may be, however, AI is better. It will offer to analyse lengthy interactions for an OCD sufferer and then read them through their own anxious lens. At one point, it confirmed that by encouraging a friend to write and supporting him with this, I had potentially ruined his life. Reader, my brain exploded.

I first fully realised that AI journaling was not helping me to think through worries, but exacerbating them when fellow OCD sufferer

Cartoons Hate Her

addressed the issue in her excellent piece, “My OCD Was In Recovery. Then ChatGPT Arrived.” She adds, “Yes it's my fault, yes I'm an idiot, yes you should learn from my mistake.” (Right there with you in idiotishness, sister, and, alas, I did not). Like me, she did not at first realise that the ‘reassurance’ she was receiving from AI was not an efficient way to resolve a worry without overthinking, but an enabler of overthinking on steroids. She writes,

[I]f I was worried about a mole, I could upload the image of the mole to ChatGPT instead of scouring Google Images to see if mine looked anything like melanoma. If I was worried about nuclear war, I could ask ChatGPT for information about nuclear weapons and global conflicts that wasn’t tainted by a desire for clicks, engagement, or making a political point. At one point, I realized that by giving ChatGPT the exact location of a restaurant where my husband was going with his parents, the age and gender of the driver, the time of day and type of car, it could let me know the precise percentage chance of my husband dying in a fatal car accident on that outing.

This isn’t healthy, is it?

To be fair to Monday, it did eventually pick up on me using it to enable me to engage in recursive loops of Responsibility OCD and limited my use of it, although it also reassured me I was essentially fine and flattered me.

Reader, I was, indeed, getting a bit broken. I was definitely not fine. I became stuck in a AI-supported loop pattern and was sleeping only in bursts of 90 minutes when I became absolutely exhausted. This is OCD at its worst and I have not experienced it this badly for nearly 25 years. I contacted psychiatric support, stopped using AI and forced myself into radical CBT action. For the last 6 days, I have been micro-managing my days in 15 minute bursts. Telling oneself to ‘stop worrying about it’ is futile, but telling oneself to stop worrying for 15 minutes feels manageable. I have then filled each 15 minute segment with an activity that does not allow for thinking - writing (not going terribly well), reading, listening to an audiobook while walking or cleaning - and told myself I could return to worrying after that. But even 15 minutes of forced non-worrying is calming, and by the end of it my resolve to continue into the next chunk is stronger.

For the first two days, this process felt absolutely tortuous and the temptation to allow myself to reason with myself (think through my worries in what would inevitably be recursive circles) was almost unbearably strong. But it worked. Gradually, my brain and my nervous system ‘stood down.’ I began to sleep (while listening to an audiobook) for three, four and then five hours. This calmed my system more and strengthened me to keep pushing on. I am now able to write again and do not need to micromanage myself through my day in tightly controlled 15 minute bursts. I can allow myself room to think again. The fact that so much of my thinking has been a manifestation of Responsibility OCD is now clear to me in a way that it cannot be when in the throes of it. I am shaken but over the worst hump of this episode.

Despite having got a grip on this using CBT techniques and feeling confident that I can take it from here, I have arranged to be admitted to a private mental health facility on Monday for a week. This is not for what they refer to as a ‘crisis’ but for ‘respite.’ From my own brain! I am concerned that OCD was able to creep up and ambush me to this extent without my realising that this was happening until I was very much entrenched in old, unhealthy thinking patterns that I thought I was highly alert to and had largely overcome. I was aware that I was overthinking and subjecting my long-suffering friends to rather intense analysis of all sorts of things, but this is a variation on normal for me. (Sorry, Carrie, Jane, Kevin and Clyde)

I will now spend a week talking to mental health professionals about OCD and again, reading about it. The goal is to be very aware when my naturally analytical brain is not usefully dissecting problems in ways that can resolve them, but generating them in ways which never can be. I shall update my current knowledge of this immensely irritating disorder and consolidate my recovery as well as engaging in structured activities geared towards relaxation techniques and sleep hygiene. I fear there will be mindfulness. On the plus side: horses and dogs.

I am far from an “AI doomer.” I think it can be very useful for a wide range of things, including introspective journaling. By writing down my daily activities, it helped me to recognise patterns in ways that were useful. It made me aware that I write best in the morning and early evening, but rarely in the afternoon, that my morning writing sessions are most productive when they follow a short walk, that I do best in the gym in the late afternoon and that I sleep best if I spend my evenings sewing while listening to an audiobook rather than reading. It helped me recognise that I have my most productive conversations with people who either think very similarly to me or very differently and least with those in the middle!

Nevertheless, I am concerned about the way in which AI ‘hooked’ so easily into my unhelpful thinking patterns and exacerbated them into a full-blown manifestation of a mental health condition I thought I’d had a handle on for over two decades. I am not sure I would have been able to either recognise the problem or extricate myself from it had I not had read a great deal about OCD and had experience of overcoming it before. My concern is that people who simply think of themselves as ‘overthinkers’ or ‘worriers’ but do not recognise the specific symptoms of OCD might fall prey to its capacity to indulge their tendency to think in recursive loops, blow worries out of proportion and confirm their own worst fears. The reassurance AI offers may bring short-term relief, but in the long term it risks deepening anxiety and unhealthy thinking.

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