Fueling Obsessions
By Fritha Robinson
It is well-documented that a large number of people who identify as trans have been diagnosed with obsessive-compulsive disorder (OCD), which is significant because many of these individuals describe obsessions with the belief that the next medical procedure or treatment will alleviate their distress. Tragically, far too often, this obsession has been affirmed and enabled by mental health providers who confuse helping with enabling. It wasn’t until I read about another medical scandal that I realized fueling an obsession was not unique to the current controversy surrounding pediatric gender modification.
True Stories of False Memories, written in 1993, is an important eyewitness account of the recovered memory scandal. The first part of the book is written by siblings of individuals who had false memories implanted. The second section provides an informative overview of the then-current body of research on the science of memory and how the recovered memory scandal developed. The parallels between recovered memories and pediatric gender modification are striking, particularly in the illusion of consensus used to mislead the public into believing the evidence base for both was stronger than it actually was. The third part of the book features stories from individuals who had false memories implanted and later retracted them, while the final section includes accounts from parents who were falsely accused.
Enabling Then and Now
A critical component in both scandals is how obsessive patients became and how therapists encouraged and enabled these obsessions. In both the pediatric gender modification and recovered memory scandals, therapists overlooked underlying reasons for distress, focusing instead on fueling obsessions. Currently, patients become obsessed with transitioning, and when they don’t improve, the solution is often more invasive procedures. Similarly, in the recovered memory scandal, when patients did not get better, the proposed solution was to uncover more repressed memories.
One surprising finding was that, even if a patient presented to a therapist with memories of being raped, a therapist intent on finding memories might claim those memories were not traumatic enough because the perpetrator was not a family member or parent. The patient would then be placed on a “recovered memory train,” where they were encouraged to uncover increasingly traumatic memories. They were invited to recovered memory therapy groups, where members would fuel and feed each other’s stories, often without harmful intentions. The outcomes were devastating for all involved. There was never a point where patients were “done” recovering memories. Their mental health deteriorated as finding new memories became the focus of their lives. Some quit jobs, ended friendships, cut off family, and focused solely on “healing.” This often placed tremendous strain on their marriages and young children, who were neglected as their mothers embarked on endless healing journeys that left them disabled. Worsening outcomes were not seen as a red flag that treatment was ineffective; rather, they were interpreted as a sign that patients needed to work harder to uncover more traumatic memories. There was also a medical component, with many patients ending up in inpatient facilities, heavily medicated or administered sodium pentothal.
Devastating Cost
Just as with pediatric gender modification, other factors contributing to a patient’s distress were ignored, and the pursuit of memories served as a distraction, much like a trans identity can distract from underlying causes of distress. In one case study documented in the book, Making Monsters, a woman with a terminal illness who sought therapy to come to terms with her mortality was instead encouraged to uncover memories of abuse. Tragically, she cut contact with her family as she was dying, rather than leaning on them for support as her life drew to a premature end. Another woman, who later retracted her recovered memories, wrote: “I am angry that I spent four years in therapy and never addressed that issue or countless other issues that caused me emotional harm. The issues we dealt with in therapy were the ones created in therapy. I am 38 years old, and even as I write this, I fight back tears at the waste of my life and my daughter’s early years.”
For anyone who has listened to a detransitioner lament that the true source of their distress was never explored or addressed in the rush to affirm and medically transition, the parallels are striking.
Professional Blindspots
I suspect that many therapists are not well-trained in identifying and treating obsessions, and this needs to change. In graduate school, I learned that OCD primarily involved behaviors like excessive hand-washing. I was not taught about the chameleon-like nature of this disorder, how it can manifest differently across time and cultures, or about culture-bound conditions. Yet one consistent factor, regardless of how the obsession presents, is that patients worsen with treatment, not improve. The therapeutic approach for someone in the grip of an obsession must differ from the approach for someone who is not.
We need more training on distinguishing between helping and enabling, as well as how to assess whether we, as therapists, are truly helping or merely enabling. We also need better training on recognizing obsessions and compulsions and intervening effectively.
Now, when I see a patient with obsessive tendencies (whether related to trans identity or not), I explore whether their focus might serve as a distraction from another source of distress or problem in their life. I have received insightful and productive responses from this line of questioning. However, we cannot tap into this productive vein if we fail to assess whether a patient may be in the grip of an obsession.
Fritha Robinson is a Licensed Professional Counselor who specializes in recovery from trauma and autism. Her substack is 7 Billion Chimps With Smart Phones.
Photo by Annie Spratt on Unsplash
References:
Goldstein, E. C., & Farmer, K. (1993). True Stories of False Memories. SIRS.
Ofshe, R., & Watters, E. (1994). Making Monsters: False Memories, Psychotherapy, and Sexual Hysteria. Charles Scribner’s Sons.
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