"Dear Dr. Jabour,
My husband and I are desperate for help. Our ten-year-old son has developed severe obsessive compulsive disorder. It began mildly in the spring but in the past couple of months it has ramped up alarmingly.
He can no longer function at school, or even get to school since he can no longer walk or ride his bike there without getting stuck on the way. He is continually falling into trances where we can't reach him and is obsessed with the notion that his dead grandpa will come back to life.
He performs ever-changing rituals that he believes will bring his grandpa back, despite how many times we've told him that nobody returns from the dead. A short time ago, he was a regular, bright, happy-go-lucky kid who climbed trees, rode a unicycle, played soccer, got A's in school, and loved discussing cars. Now he wants to die.
This is a child so wracked with anxiety and strange behaviour that we barely recognize him. We want our son back. Can you help us? We live in Quebec but are willing to come to Los Angeles for treatment."
When I wrote that letter back in 2013, my husband Rob and I felt so hollowed out with despair we were like ghosts you could see through. Our only child, crushed by the death of his grandpa, had transformed from an everyday kid into a faint memory of the boy he was, his every baffling behaviour designed to bring his grandpa back to life.
Magical thinking had cast a spell over our household. We also called this invisible force the "OCD Monster" and we felt powerless to stop it from enslaving our son.
That is, until I started learning about the power of cognitive behaviour therapy (or a branch of it for OCD sufferers called ERP -- exposure response prevention).
One day, early on, when Quinn's mournful why-is-Grandpa-gone crying had subsided but seemed to have morphed into something else, we were driving from our village of Wakefield to Montreal. Quinn kept rolling down his window, putting his face out into the wind, his hand on his heart, and saying: Please come back, please come back, I love you, please come back.
At the beginning of the drive, I kept turning around to say something encouraging about how I knew he could boss back his OCD monster.
"I know. I'm trying! Just one more time," he'd say, then roll down the window to do it all over again. Clearly, fighting the OCD monster wasn't easy. Sometimes, I'd wake up in the dead of night, when the truth of how things really are never wears a mask or pretends, and I'd feel gripped by a cold fear, wondering if my son would ever be himself again.
"Let's try some of those exercises," I said, trying to smile. "We'll time you to see how long you can go without having to roll down the window."
Delaying a compulsion was an exposure exercise I'd read about. Every second that goes by without obeying the compulsion is excruciating, but as time passes, the anxiety gradually diminishes as the brain adapts to the feeling of not following the compulsion. With ERP, you expose yourself to your fears.
A child who is afraid of germs, a common type of OCD, makes herself drink from a public drinking fountain which she believes is full of deadly germs. As she drinks, the anxiety level initially spikes, but gradually decreases as she realizes nothing catastrophic occurred. She's habituating herself to the anxiety, literally re-circuiting her brain. The next time, she can try doing it longer.
Eventually, the compulsion loses its appeal. But of course, this is all easier said than done. All the person is thinking about is how much they have to obey the compulsion, how not obeying the compulsion means never seeing your grandpa again. There's no logic involved in OCD.
One night at bedtime, I overheard Quinn telling Rob that he had to tap his grandpa's picture thirty-six times before getting into bed. Quinn was kneeling on the dresser beneath the picture, ready to start tapping.
"Thirty-six times? Where did that number come from?" asked Rob. "Why don't you try bargaining with your OCD like we bargained in Mexico? Tell the OCD monster, 'Thirty-six times? Are you kidding me? How about five times?'"
Quinn actually laughed. Rob continued. "And then OCD comes back and says, 'What? That's insulting! Thirty times, final offer!' And then, Quinn, you say to the OCD, 'The guy down the street is telling me only five times. Give me a break here, dude, or I'm walking.'"
Rob stomped across the bedroom as if on his way to another OCD monster with a better offer. "And then OCD calls you back and says, 'Okay, okay, how about ten times? We have a deal my friend? Ten times? Let's shake.'"
Quinn's face brightened. "Okay, wait, let me try that." He closed his eyes for a few seconds and when he opened them, he said, "Okay, I made a deal. Eight times." He proceeded to tap the picture eight times. When he jumped off the dresser he looked triumphant.
As the weeks went by, the OCD monster continued to lurk in Quinn's brain, slithering through trapdoors and finding hidden passages, but gradually, with ERP, and with some unexpected community healing power, the monster finally, one day -- in a way nobody could ever have anticipated -- vanished for good.
Three years have passed and the monster has never made a comeback.
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