‘What if I’m a paedophile?’ The intrusive thoughts that haunted Uma

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This episode discusses sexual abuse as well as suicide. There's also a couple of swear words in there. Take care while listening. Can you describe your earliest memory of an intrusive thought?

I was probably three or four years old, very, very young before going to school. And I was being taught prayers. by my parents. There was a set of 12 prayers. in Hindu tradition that they taught me and I began thinking what if my parents don't come home alive and I need to control that by doing these prayers. 39 times. So that cycle of 12 prayers, 39 times, which became intrusive thought. They might die if I don't do this. And compulsion, that. Why 39 times?

Great question. It's just actually it's the number three has been a number that my brain has arbitrarily decided is safe and good. And so three times three is nine, which makes it even better. But three and nine together somehow in my little brain. It's very lucky. Yeah. This is Uma Chatterjee. She's 29 years old. She's currently working on a PhD in neuroscience on the neurobiology of obsessive compulsive disorder.

But as a preschooler, when she was already reciting prayers 39 times, she had no idea why her brain was doing this to her. She had no idea it was abnormal. When would you be doing these prayers? Was it at night before bed kind of thing? How long would it take for you to get through all of that? Before I was in school, it was just in the evenings where I would have to be in the bathroom. Again, none of this makes any sense, but I was actually taught these prayers while...

in the shower with my parents, not in a weird way. Like it's just, you know, they give you a bath, they give you a shower. So they use that time to teach me these prayers. So I think that's why I did them in the bathroom. I was so terrified and so scared when I was doing them, obviously, because this is an intrusive thought wrecking.

a child's brain and so I'd be like sobbing I'd be so scared and if I interrupted it or if I didn't complete it I have to start it all over again because I had to do it perfectly

From ABC Radio National, this is All In The Mind, I'm Sana Khadar. Even if you don't have OCD, which most of us don't, you have probably experienced intrusive thoughts before. They're these unwanted ideas or images that sometimes pop into your head without warning. They can be low-key weird. They can also be violent or sexual. Like, what if I just swerved my car into oncoming traffic?

What would happen if I stole this thing I just picked up from the shops? What if I kissed my coworker in this meeting? While these thoughts can be disturbing, they're also, for the most part, very normal most people without ocd are like ew that's a weird thought like moving on with my life so today we're asking why do we get intrusive thoughts and what happens when they take a dark turn and spin out of control it was

a huge yo-yo from everything that I experienced before and my life just fell apart in the space of a couple of months. I had a pivotal moment at 12 where I... experienced sexual abuse by a not-immediate family member chronically. Because of the sexual abuse and not being believed, my brain latched onto, essentially, what if you're a pedophile? Hello, hello, hello? Hello. Hi, how's it going?

I'm so glad. For as long as Uma can remember, she has been governed by this idea that she is a bad person. And I'm responsible for everything bad that happens. And so she needs to work really, really hard to be a good person. And so when it came to those prayers, she would recite for her parents? I could do it hundreds of times, like at its worst, but I had to say the 12 prayers 39 times without interruption. Wow. That's really fascinating to me.

don't have OCD. But one thing this reminds me of is I had a very similar kind of thing as a kid around worrying about my parents dying, having prayers that I thought would keep them safe, and like needing to say them before bed for me. Maybe it was more like 12 times over kind of thing, but I had to be.

And it was like in sets of three over and over. And that was a very similar thing, but it obviously didn't evolve to something more serious from there. You make such a good point, though, that obsessive compulsive disorder is at a certain point on a spectrum of behavior that...

everybody's intrusive thoughts and many people have habitual behaviors that they engage in with their certain intrusive thoughts once in a while. And that's why people tend to conflate that with OCD and being quirky. I'm not saying you're saying that. I'm saying that actually you're making the point that like it starts. That frames up my first question pretty well before we get deeper into Uma's story, which is...

Why do we get intrusive thoughts in the first place? You know, the question's a complex one. We don't really know. Well, that's a letdown. But psychiatrist Professor Vlasios Braculius has some ideas. It may have something to do with the subconscious, you know, these thoughts just emerging into consciousness because, of course, when we dream, our mind's active and thinks of various things.

And I think it would be similar in the daytime that we can think of random thoughts. And I guess we're more likely to think of these random thoughts when we're a little bit more relaxed and less stressed or pressured. That's because when we're relaxed, our brains have a chance to daydream and self-reflect and generally wander. Which brings me to my next question, which is, why are intrusive thoughts generally so weird or disturbing?

Again, we don't know, but just like sometimes dreams, you know, these are subconscious thoughts and they tend to reflect some of the instinctual feelings that people have. They might be embarrassing. They might be... against what we really wanted to or against the ego so if you think of the freudian psychology the ego is there to

to control that subconscious thought. And of course, it's against it. So the thing that you very much don't want to do, it pops up into consciousness. And when we're conscious and we're alert, we can just... dismiss that thought very easily, but it varies as to how much people can dismiss those thoughts. And that variation is how you can land in disorder territory. Intrusive thoughts can become obsessions if they become more frequent and distracting and distressing.

For a clinical diagnosis of OCD, someone needs to have obsessions, which are the recurrent and persistent intrusive thoughts or even images, or compulsions. repetitive behaviors or mental actions like praying or counting or repeating words in your head, or both, compulsions and obsessions. To meet the diagnostic criteria, these also need to cause significant distress.

or take up a significant amount of time each day, like more than an hour. OCD affects 4% of the population in Australia, and that's a similar figure worldwide. And there are various clusters of symptoms or subtypes within OCD. You might be most familiar with the contamination subtype. Worried about germs being contaminated and may spend hours washing their hands or showering. Or the doubt and checking symptoms, where a person might, for example, think they've left the oven on.

and they have to check again and again and again. Or the order and symmetry symptoms. So needing things in the right place or not being crooked.

But there is a version of OCD that gets talked about far less because it has to do with taboo thoughts. And these may be aggressive obsessions, sexual obsessions or religious obsessions. And as Uma Chatterjee grew older, it's these kinds of thoughts that would escalate severely. OCD, I tend to say, latches on to anything and everything that life...

can bring at you and anything that you value. And that now I understand is related in large part to the neurobiology of OCD. But going back as a kid, you know, I cared about people being alive. I cared about being safe. I cared about being a good person and being loved just like anyone. else does. So naturally my OCD latched onto that. As I got older, I started becoming consumed by, am I causing people harm? I used to be so afraid of potentially harming my friends and I had no basis to.

base off. I was going to harm my friends, but I was so afraid of like falling on them or hitting them or losing control. And I was afraid of saying horrible things like blasphemous things. And then I had a pivotal moment at 12 where I... experienced sexual abuse by a not immediate family member chronically. And that in combination with then not being believed and not getting any help, my brain just like more so broke than it already had. And I already had OCD and it was already clinical.

But after that experience, Uma says she eventually developed PTSD and depression, and she started to self-harm and attempt suicide. But in terms of OCD... Because of the sexual abuse and not being believed, my brain then completely latched onto, what if I do not have a grasp on reality? What if I'm lying? What if I'm making these things up? What if I am a monster? Because I was then told how horrible it was to accuse someone of these. things that I then learned were sexual and whatever. And

Then, because I also started becoming a babysitter to like earn money and get out of the house, like later in my teenagerhood, my brain latched onto essentially what if you're a pedophile? Like what if you do the same things that happen to you, which is actually an incredibly common theme for OCD.

that most people don't name, which is why I really love bringing that up, or I feel the need to bring it up in interviews like this. This kind of obsessive thought is common enough among people with OCD that in the research literature, it's sometimes referred to as POCD. Pedophilia-themed obsessive compulsive disorder. You can imagine how distressing this would be. These people don't want these thoughts, they don't agree with these thoughts, but they're bombarded by them.

There are so many people who have these intrusive thoughts that have no basis in reality. It's just the intrusive thought that every human has, actually, of just like the most blasphemous random things having this like intrusive image. Most people without OCD are like, ew, that's a weird thought.

like moving on with my life. And because of the brain, people with OCD, they're like, oh, what does that mean about me? What if that means I secretly want to? What if I actually did do it? And I don't like it could just go on and on forever. If this is news to someone, if someone is just learning about this true face of OCD, you've really got to expand your mind to the wide range of things.

that you can get obsessed over. This is Martin Ingle. He's a 35 year old writer and filmmaker from Brisbane. His journey through OCD is a little different to Uma's in that he didn't struggle with his mental health as a child. His OCD came on suddenly in his 20s. If you can be afraid of it, if it can bother you, you can get obsessed with it. And that's what makes this so difficult to talk about. It's easier to talk about...

being obsessed or being afraid of germs. It is less easy to talk about being afraid that you are a sexual deviant. It's much more difficult to talk about that you are afraid that you're accidentally going to drown your baby in the bath. Those things are so difficult to talk about, but it's the same kind of obsessive spiral. Martin has spoken publicly about his OCD before. He's been on shows like You Can't Ask That. And he finds the process of talking about his OCD freeing.

So try to imagine the equivalent. If someone's washing their hands to the point where they're bleeding as a compulsion, then what might someone do if they were afraid of hurting somebody? I would... not leave the house. I would avoid members of my family. I lost a lot of work because I didn't want to do work around certain people. I retreated from almost all aspects of my life. When it came to sexuality, I stopped any kind of sexuality at all.

Even masturbation. I was so afraid of the possibility that I might be a sexual pervert that I cut off those parts of my life completely. Even the presence. The presence of these doubts in my head was too much for me to cope with. Those are the sort of extreme things I did in response to my intrusive thoughts. I've heard stories of people...

who willingly give up their children because they're afraid they are going to hurt them. Uma also developed a range of compulsions to try and keep her taboo thoughts at bay. They consumed her life.

Mental compulsions were really what they were. So for me, it was tons and tons of rumination and trying to figure it out. Like, is it true? Did I do this? What does this mean about me? Blah, blah, blah. Lots of thought stopping, like try to make the thought go away. end, which doesn't work. Like I tell you, don't think of a pink elephant. What are you thinking about right now? Pink elephant. Literally a pink, literally. Thought-stopping doesn't work.

And a lot of just vigilance around the thought itself. So if not trying to stop the thought, then just like thought, don't come near me. Like if you come near me, if you pervade my head, like this is going to become true. And that sort of feeds into this.

concept in OCD of thought action fusion, where people think that their thoughts equal actions and their thoughts are going to change the world, which is irrational and untrue, but it feels true. So it's doing a lot of mental actions essentially to get your thought. to not become real.

And then there were also, again, physical compulsions, like later down the line, like I used to record every single conversation I ever had, like even going through the freaking drive through, like, oh, did I accidentally hurt someone or lose control? And I don't remember what I actually said. And so I need to.

record every single conversation. I used to have like several charge devices with me at all times to make sure I could record every single conversation I ever had, which is obviously illegal, but also don't hold that against me, but it's also just, you know, horrific, right? And then I'd have to go like, listen to them again. check that you hadn't been a bad person? Yes. Or that I hadn't lost control or said things that I, and not realize I did that. It might not surprise you to learn that...

By the time Uma was diagnosed, she met the criteria for an extreme level of OCD. From ABC Radio National, this is All in the Mind. I'm Sana Kadar.

As a psychiatrist, Dr. Vlasios Braculius says he tends to see OCD patients who are struggling with these taboo thoughts in particular. And is that because they're so distressing? Yes, I believe so. You know, I wonder if it leads people to feel suicidal at times, these kind of thoughts. Yes, there's about a 10% rate of people having thought of suicide in the last...

months. So it is certainly a risk because of the distressing nature. Now, if this is the first time you're learning that people with OCD can be afflicted with pedophilia themed obsessions,

you might be wondering what makes them any different from a person with an actual interest in children. Dr. Bercoulias says, the difference is, for a person with OCD, these thoughts are so unwanted and... terrifying so these are what we call ego dystonic thoughts they against their ego and they think oh that was a terrible thought where did i get that terrible thought and it's distressing for them it confirms to them that they

actually don't want to do something terrible like that. How well known do you think it is that these kinds of thoughts can be elements of OCD and they don't mean that a person is in fact a pedophile, it means they are struggling with OCD? It's not well known. And even amongst our medical colleagues, sometimes we get referrals saying, we're not really sure what this means or if there's any risk involved with these thoughts.

And they're not symptoms that people will talk about either. And they're not obvious, like the other symptoms, you know, where it's obvious that someone's going back and checking or washing their hands a lot. These are hidden thoughts. They're very embarrassed about them. So it's not like... they know that other people have the same thoughts as them. That is one of many reasons why it can take on average at least a decade from the onset of symptoms to a person getting a diagnosis of OCD.

Uma Chatterjee was 22 years old when she was diagnosed. I was diagnosed because I finally googled. like for the umpteenth time but I googled the right thing that then told me I might have OCD which when I was 22 like I also thought OCD was just like oh my gosh like I'm so OCD like I'm so clean about my room like and I did not follow that at all I was actually very dirty

And I was like, how the fuck is this OCD? But then I understood a little bit more about it. I brought it to a psychologist. And that's when she finally got the diagnosis. But even then, it took a number of years before she would get the treatment that helped her.

She's like, okay, so let's do talk therapy. Let's do traditional cognitive behavioral therapy where we do things like thought stopping. Remember how I told you that doesn't work and it's not evidence-based for OCD. Let's do psychodynamic therapy where we find the deepest, darkest traumas.

that caused why you're having these intrusive thoughts, which is also not evidence-based and harmful. And anyway, so I say this because I got diagnosed by sort of bringing the diagnosis to them, which is pathetic. And then...

got incorrect treatment that may be worse for three more years, and I finally got evidence-based treatment for the first time at 25. That evidence-based treatment is called Exposure and Response Prevention Therapy, ERP. It's actually based on CBT principles, but it's a modified version. It is the first-line, gold-standard, evidence-based psychotherapeutic modality for OCD that's been research-backed and evidence-based for almost 50 years.

And so how does that work for someone who's never heard of it? How did it work for you? What did you do? Yeah, it was life-changing, and it sounds really antithetical, but... it makes complete sense when I'll describe it. So exposure or ERP means exposure with response prevention. So step one is exposure. And exposure means that... We take the intrusive thought, the what if, or the intrusive image, or whatever the hell, and you have to actually force yourself to face it and to think about it.

Or to experience it. And then step two is response prevention, where... You don't do compulsions even though you're having the obsession, which sounds really simple, but it's incredibly, incredibly difficult to the point where there's an extremely high dropout rate because it's...

torture, honestly. And I don't mean to say that to discourage anyone. I'm just naming the truth of it's the hardest thing someone with OCD can do because our brain is wired to protect us. So the whole reason we develop compulsions is to get away. from how overwhelmingly distressful obsessions are and what are we being asked to do? Face those obsessions and then not do those behaviors. And so walk me through, can you, if you're happy to, a particular thought that you...

did this on and like the compulsion you had to stop like give me a particular example of how you use this yeah so let's just go with pocd because i already named it pedophilia ocd so Oftentimes, I would see a child and my brain would go to...

What if I would harm them, like if I were around them? Like, it's just a question. And it's just a question of a fear because I have this deep, like, because the last thing I would ever want to do as a human being is harm a child in any way. OCD attacks what we value.

So I care about the well-being of children. I would like to be a parent one day. So the last thing I want to do is do that. So naturally, my brain, if I see a child, has the... intrusive thought of what if I were to harm that child what if I'm a monster what if I'm a pedophile and so what I used to do the compulsions were to then sit there and spin and think about have I ever done anything like that before

But even if I don't think I have done anything like that before, what if I actually have? What if I have lost control? Let me think of every single instance I was around a kid before. That's what a compulsive version would be. And in treatment, what I have done quite literally is I have the thought. And what I have to do is be like, yeah, okay, that's a thought.

My brain's making a thought right now. That's cool. Like there's different techniques. Sometimes it's just neutrality of like, oh yeah, like just mindfully observe. There's a thought, but I'm not going to act or do any behaviors. I'm just going to keep doing what I'm doing. Not in a compulsive, I need to distract myself and get away from the thought way.

But just like, for example, I'm typing up my research paper for my lab and I have the thought randomly because I'm writing about children and OCD. Like that very much actually does happen. And it's like, yeah, okay. Thank you, brain, for making a thought. Moving on. Like it's just literally not. doing that behavior. And what happens is that when you have that thought, you're

distress. So the experience of anxiety or panic or fear or disgust or shame or just many negatively valenced emotions, they come up. Right. They're coming up and the whole point of compulsions is to bring them down. But we have to do is let them come up and go up and up and up and sit with it and stay with it, which is like this is the worst thing that could ever happen to you. Right. But what you learn is that if you.

that you can tolerate that amount of distress. And you're able to learn that next time this happens, I can handle it. Like it fucking sucks. Like it sucks living with OCD. Like I'm not curing it or making it go away, but I'm learning how to not let it take over my life. By not doing that behavior, you're able to engage in inhibitory learning and learn how to tolerate the content of that thought. So that's how ERP works for mental compulsions.

It can look a little different for physical compulsions, where a person has to physically do or not do something. Like... If you have contamination OCD, for example, it might mean exposing yourself to dirt and then gradually getting to a point where you don't immediately wash your hands.

Exposure response prevention therapy has been similarly life-changing for Martin. He's the writer and filmmaker from Brisbane you heard from earlier. It's really interesting because I have memories of being... a fully grown adult without having this illness and then witnessing my brain change i feel like i've lived in two different bodies i feel like i've lived in two different brains and i

know having gone through treatment now, the treatment for your obsessions or for lack of a better word, your fears is a really good lesson for everybody for how to approach their fears. And it's just that for us, it's way more pronounced and way more extreme and way more sticky. So to treat your obsessional fears the best.

technique we have now is to expose yourself to those fears. Because what OCD wants you to do is to retreat, it's to restrict, it's to protect yourself from those things you're afraid of. What our doctors teach us is to do the opposite, to expose yourself to the things you're afraid of, to continually grow, to continually push yourself and work that muscle.

and get more resilient to the things that you're afraid of. And that is a lesson for everybody. I could have learnt that lesson before I had OCD. That would have been very useful. It's just for us. with OCD, it is incredibly, incredibly painful when you have someone who thinks that their or someone else's life is on the line if they don't do this certain thing, if they don't tap this table.

a certain number of times. I hope that in the future we don't have to do it because it's really, really painful. I hope there's something better in the future. It's kind of like walking through the fire to get out the other side. There's no way out of it without going through the pain of that fire.

It is tempting to see the stories of Uma and Martin as a kind of hero's journey. They face these huge, painful obstacles, discover they have OCD, learn more about it and seek treatment, and eventually overcome the disorder. But that's not what they told us. The reality isn't like that. Well, I've lived with this for just over 12 years now. I still live with it.

every day. It's gotten better. I'm now no longer shutting myself in my house. I don't really wet my pants very often because I'm afraid of going to the toilet. So yeah, therapy has helped me. be able to function a whole lot better but i'd be lying if i told you this isn't in my brain at every moment of every day it does not go away And it's incredibly painful. You become used to it. You become resilient. You become kind of numb to it. But the pain never really goes away. And...

You learn over time to accept that and to just keep on trucking because there's nothing else you can do. People with OCD are 10 times more likely to die by suicide because of the shame, because of the stigma, because of the lack of access to treatment. I know multiple people who have died by suicide from this condition. for all the people who have died and all the people who are suffering so badly, it takes just-

It's a simple conversation like this to change someone's life and not in a way where it's me changing it. It's just the information and the content. And how could I not do that after being given this other lease on life that, I mean, I should be dead on so many accounts right now. How could I not just speak? the truth. And the shame only exists because it

we're shamed for it and we are sitting in the darkness. And the only thing we can do to combat shame is bring light to it. And to me, that's talking about it, even when I will be judged, even when people will listen and still think I'm a monster and not take the time to go learn about what it is.

you know what? I don't really care. Even if one person gets the help they need from listening to it, I don't, that outdoes anyone judging me. And honestly, no one can judge me harder than I judge myself anyway. That is all in the mind for this week. That was a pretty intense episode. If this program brought up any issues for you, you can contact Lifeline on 13 11 14. Insane Australia also runs an OCD helpline. You can reach them on 1300 269 438.

I want to say a big thank you to Uma Chatterjee and Martin Engel for sharing their experiences of OCD and being so honest about their experiences. Uma is currently working on her PhD on the neurobiology of OCD at the University of Wisconsin-Madison, and Martin is a writer and filmmaker from Brisbane. Thanks also to psychiatrist Professor Vlasios Braculius from Westmead Hospital and the University of Sydney.

Thank you to producer Rose Kerr, senior producer James Bullen, and sound engineer Tim Jenkins. I'm Sana Kadar. Thank you for listening. I will catch you next time. You've been listening to an ABC podcast. Discover more great ABC podcasts, live radio and exclusives on the ABC Listen app.