Conversations Between Friends: Cynthia Marie Hoffman and Emily Costa
Cynthia Marie Hoffman and Emily Costa are both authors of memoirs about obsessive-compulsive disorder (OCD). Costa’s Until It Feels Right is a diary-style account of intensive three-week therapy for OCD. Hoffman’s Exploding Head is a collection of prose poems spanning a lifelong journey with OCD from childhood through the present day.
Both books invite the reader into the deeply vulnerable interior of the obsessive-compulsive mind. They work to challenge stigma, broaden the scope of understanding about OCD, and build connection. Over the course of this conversation, this prose writer and prose poet discover, despite their different approaches, just how much they have in common.
Cynthia Marie Hoffman: Emily, I was hooked on Until It Feels Right from the first sentence: “This thing starts in sixth grade.” As someone who also experienced childhood-onset OCD, nothing could have rung truer to my ear than your choice to call it “this thing.” I have a poem in Exploding Head called “It Starts.” These words—“thing” and “it”—are loaded with the immense strangeness of those first OCD thoughts for a child who has no diagnostic language to name what is suddenly happening.
When I first sat down to read your book, I knew I was going to be reading a memoir about OCD. But I realized there’s no synopsis on the back cover. In fact, you don’t name the diagnosis in the text until “my OCD brain” appears on page fifty-one—halfway through! When did you first know you had OCD? And why did you withhold naming the diagnosis for so long in the memoir?
Emily Costa: I didn’t realize this! It wasn’t intentional, but maybe by that point I was finally able to extricate it from myself. Before that it was so completely a part of me. I couldn’t separate it. Now I view it as a parasite; I think of a little creature from a horror movie, influencing a host’s brain.
I first knew something was wrong with me at the age of five, when I started constantly worrying, but I didn’t have a name for it until sixth grade, when my first rituals began. And not because I got a diagnosis, but because it was in pop culture—Monk was on, Monica from Friends was high-strung and particular. These versions of OCD didn’t match mine, but that was when I started thinking, Oh, I’m not alone. When it became debilitating, around ninth grade, I went to a psychiatrist and got diagnosed.
All that early stuff, the not having the language for it? That’s what broke my heart in your book, a child grappling with these impossible ideas and then staying quiet. The line “It was exhausting being good” from “Scar” cemented it: this feeling like, Someone really understands. I read that section through tears because you show the loneliness so well.
CMH: I started writing this book because of loneliness. I was in my thirties, still exhausted from the effort of hiding, and I finally just had to open up. But it wasn’t a floodgate. It was like turning the faucet on drip.
I couldn’t say “OCD” out loud yet. I brought those first poems to my critique group with a disclaimer that I wasn’t ready to talk about the subject outside the world of the poems. And that trusted circle of readers took my work at face value as I shared what it felt like in my brain—dark, scary, lonely—unattached to any diagnosis that might have diminished the perceived intensity of my experience or that might have explained away my most troublesome thoughts as “symptoms.”
In a sense, I’m glad I wasn’t ready, because it forced me to reinhabit the way I experienced OCD as a child, before I knew what it was. All I knew was that I had to count the four sides of window panes, I mentally drew stars on the seven points of people’s faces, and doing those things made me only slightly less anxious about the visions I was having of my loved ones being shot. I didn’t know how to say any of those things out loud. It took many years to find my voice, and ultimately, I found it through poetry.
And I have found connection. We all have intrusive or impulsive thoughts, so I think everyone can relate to the poems on some level, whether or not they have OCD. My book is also for anyone who has experienced anxiety or depression—you know, just being a human on this earth.
Until It Feels Right: “The ritual crystallizes and forms an order. I walk clockwise around the room, door to dresser to closet to bed, back to door. […Do] these things or else you will die.”
Exploding Head: “The rules are: count the sides of the rectangles. Graves. Gravestones. The rules are: if you don’t count, you’ll die.”
But speaking of voice, how did you find the voice for your memoir? It’s so engaging, urgent, vulnerable, chatty, and often funny. I feel like you’re talking directly to me, and sometimes I feel like you’re texting (“like I know anything at all lolol”). I feel your exasperation. (“It sounds so stupid written out,” you admit at one point.) You title your chapters with the date of every Monday through Friday of the three-week period of intensive therapy. Did this memoir start as a diary?
EC: Yes, it was a daily therapy log. Part of why I started it was accountability but also the impulse to document; I still have a notebook from the grief therapy I did as a child, and one from when I was hospitalized as a teen. But I also keep, like, old checks my mom wrote in 1995. So, who knows.
Part of it, too, was some urge left over from my online diary days. With that comes the idea that the audience isn’t just me. It could be, but I’m still putting it out there for anyone to read. I can see now that my online diaries were attempts at connection, so I figured there might be something worth exploring in my cognitive behavioral therapy (CBT) diary, especially to combat the loneliness. I made this kind of “art goal” of making a zine of the diary, maybe because I couldn’t imagine what my “mental health goal” would actually look like. Even if it turned out nobody cared, it would be fun to print all of it out, collage stupid pictures. To actually make something.
As for the voice, yes, it’s just me talking. Which is definitely not for everyone! But I really wasn’t looking back too much at what I was writing until I connected with Michael Wheaton from Autofocus, who saw me tweet about my zine idea.
Your book’s second-person voice intrigued me too. I love when you blur reality (reality-reality versus OCD reality), like in “You with the Getting Shot” (“It is a crisp autumn day when you get shot walking by the parking lot on your way to the lake”) because that separation of worlds is always so murky. You illustrate this brilliantly. My own first attempts at writing about OCD were always in the second person, probably because I wanted distance. Was this something you thought about while writing? How did you arrive at that voice?
CMH: In the beginning, the second person was a safer way to gain entry into writing about an incredibly vulnerable topic. But as I kept writing, I realized that the second person was also more accurate. Years ago, I read a popular self-help book that encourages people to say, “It’s not me, it’s my OCD.” When the first poem in Exploding Head says, “You are not you again today,” that’s distinguishing the true self (the “you”) from the OCD self (the “not you”).
But I couldn’t agree more that the line between them is so murky! And I think that murkiness is the goal of OCD—to make us doubt ourselves.
Although parts of that self-help book made sense, I also felt a strong resistance to the suggestion that I should dismiss OCD from my identity altogether. I’ve been living with OCD for as long as I can remember. How could it not have made me who I am today? It took almost forty years to recognize the value in letting the OCD part of me speak. And in the end, I think because OCD expresses itself so defiantly in opposition to the values at the core of my identity that my identity has strengthened. I’m even more sensitive, more empathetic, gentler.
Emily, you describe a similar duality of selves in your memoir when the therapist urges you to create a “character” for the OCD voice. But overall, the CBT treatment involved a lot of the same practices as exposure and response prevention (ERP) therapy. There’s the exposure you did for therapy, but there is also the exposure that happens over the course of writing this book. For example, you say, “Just got really grossed-out typing all of this.” And, “(I hate typing this).” How did the act of writing this memoir impact your healing?
EC: Putting the book out there was an exposure, but because I’ve been trying to write about my mental illness for a long time, it was more the diary aspect that freaked me out. Rituals are bizarre, especially mental compulsions, because no one but the person doing them really witnesses them.
Another thing was I gave a copy of the book to my therapist during my last follow-up session. I almost didn’t; I couldn’t decide if it was stupid or embarrassing but I did it anyway, and his response was maybe the most meaningful thing for my treatment. Now I do group therapy focused on “compassionate accountability,” and I meet with other people with OCD, and that’s helped with the loneliness.
Writing kept me accountable, but being able to hold my book, to be like “Here is proof I tried,” is what has been healing. And healing in a more abstract way. OCD never goes away. I’m just better able to understand what my brain does, and I can choose how to respond to the bullshit it gives me.
Until It Feels Right: “I am stuck on multiples of four. I like the balance of four, like legs supporting a tabletop.”
Exploding Head: “You might have had a brilliant mind. But you were busy counting the four wheels beneath your bed.”
There are poems in Exploding Head that deal with techniques I recognize, poems like “This is How to Be Happy,” and “Therapy,” and “Uncertainty,” but as mentioned earlier, our books show different things, despite their overlap. Did you have a healing experience during the writing process?
CMH: For a long time, I was just writing poems about various OCD topics, and I was desperately looking for the arc that would make it a book—evidence of how certain OCD themes had gotten better. Like, did I become less afraid of guns? (No.) Do I think about the house exploding less often than I used to? (Nope.) I just wasn’t finding it.
It didn’t occur to me until very late in the process that I could put the poems in chronological order. And it was only when I sat down to read the poems from childhood to present day that I found the arc of healing that was already there.
The poems I’d written about my childhood were painfully lonely. Reading them all together, I could see how afraid, lost, and confused I had been. But as I grew up, I gained a better understanding of my own mind, and I realized that I was addressing myself in a more compassionate way in the poems that progressed through adulthood. The scary thoughts were still there, but they were no longer the main character. Reading the manuscript from start to finish helped me recognize that I’d done more healing than I’d given myself credit for, and it helped me redefine my own expectations of what “healing” looks like.
I’m also discovering that we don’t need to earn the right to tell our stories by proving that we’ve sufficiently come out the other side. If we always waited until we were fully recovered before we wrote about our experiences, we’d never write about them. And we’d lose a whole canon of writing that fully embodies that rich and urgent perspective of being “in it.” Hindsight is twenty-twenty, but what do we lose by looking back with perfect vision?
EC: I agree. There’s change no matter what, just by living. Like, I’m in the middle of this flare-up—certain intrusive thoughts are stickier than others—and it’s horrible, but I know it doesn’t feel like it did a few years ago. Or it does, but I’ve changed. I have different tools now. And I know that because I can read what I was feeling like two years ago.
Until It Feels Right: “What is being happy all about? Can I even think about it? I don’t know.”
Exploding Head: “It’s okay if you’re starting happiness from scratch.”
Commenting on the status of my OCD still feels strange, even though it’s the OCD that’s telling me I’m jinxing myself. Even here, as I write this, I’ve deleted a few sentences detailing symptoms because sometimes going too far into detail gives it power, like I’m believing the thoughts. It’s tricky, because, in some cases, saying it helps, and in others, it’s adding fuel to a fire.
Does OCD affect your writing, your writing habits? Has it impacted your hopes for the book’s reception?
CMH: I’m not sure whether I’m better or worse for all the attention publishing this book is forcing me to pay to my OCD. The thing that makes OCD better is not paying attention to it, letting the scary intrusive thoughts pass through without reacting or indulging in rituals. But writing a book makes you think about it. Then, talking about that book makes you think about it. And then I think about how much I’m thinking about OCD. And then my OCD says maybe I don’t even have OCD, so that’s a whole thing that probably wouldn’t exist if I hadn’t written the book.
As a poet who writes “project books” (and also as a person with OCD), I’m used to being immersed in a single obsession for years. When I was writing my third poetry collection, Call Me When You Want to Talk About the Tombstones, which is about making pilgrimages with my mother to our ancestors’ homes and gravestones, and essentially grappling with mortality, I couldn’t drive past a graveyard without feeling upset. Some days I would cry. And I already had a whole OCD thing about graves: I couldn’t blink while looking at a grave or a graveyard, and I couldn’t breathe while driving past a graveyard. There wasn’t a route to work that didn’t pass a graveyard. It was a dark time. But I felt sure that I was working on something meaningful. And I felt equally sure about my OCD poems.
I’ve been referring to Exploding Head as an “OCD memoir in prose poems,” as if that explains it all, as if anyone who hears that will immediately call to mind a rich, complete picture of “OCD poems.” But as the book has started to find readers, I’m reminded that not everyone has the same expectation of what kinds of things might be in an OCD poem.
OCD can mean being obsessed with finding a dead body by the road; worrying your house will explode; or visualizing being shot while driving, while at the park, or even while sitting in your own living room. OCD can mean you’re dealing with disruptive, seemingly illogical compulsions to count or to rewrite snippets of conversation in your head until they have the right number of syllables to match the number of panels on the door. It’s scary, embarrassing, and sometimes terrifically boring to talk about these things. None of the actual realities of OCD would sell as well on a T-shirt as “Obsessive Christmas Disorder.”
More than once, early readers attributed certain symptoms that appeared in the poems to schizophrenia, likely due to a lack of understanding about the vivid, sometimes almost hallucinatory quality of OCD. It was unsettling to be misdiagnosed, and that’s when I decided I needed to be forthright in labeling the book an OCD memoir, partly as a self-protective strategy because, even though the poems themselves don’t name OCD, my book is not meant to be a “guess the diagnosis” whack-a-mole sort of thing. But also because maybe someone will read my book and think, “Oh, I didn’t realize OCD could be all that.”
Emily, since your book was published a year and a half before mine, can you talk about what the response has been like over that time? Do you have any advice for others who want to share a similar story, or any regrets? And what are you working on now? Are you done with OCD, or is there still more to explore?
EC: I’ve made wonderful connections through this experience, people with and without OCD. People who I thought wouldn’t read it did, and people who I’m closest to haven’t. And they don’t ever have to! It’s just interesting how it pans out.
You mentioned your own heightened sensitivity, and I feel similarly. Maybe my advice for others would be to try to ignore that part for as long as you can during the writing/publishing process? Could be bad advice, but that’s what I tried to do. I have a streak of idiocy within me that propels me to write about this personal stuff, to even try to be a writer at all, but then I have the thinnest skin. Just a huge baby about all of it.
I need to reckon with that, because I’m diving into this book I’ve been working on since 2019. It chronicles the arc of my parents’ marriage against the arc of my dad’s video store. I’ve been so worried about writing it as creative nonfiction, or fiction, or some combination that I’ve locked myself out of it. But I’ve healed a bit more, and a lot of resentments I’ve held onto have melted away, and I just want to have some fucking fun writing. I don’t want to write about OCD anymore, but I’m sure it’ll be there because it’s always there. It’s shaped me. Besides that, I’m working on a hybrid thing about my hometown mall, a minichap of music-related creative nonfiction stuff, and a short story collection.
Do you feel like you’re done writing about OCD? What projects are you working on next?
CMH: I appreciate hearing someone else say they’re writing personal stuff but have the thinnest skin. That’s me! I think I mostly avoided writing about personal things because the thin-skin part of me scared me off. In college, I published a personal essay in the undergraduate literary journal. A professor I highly respected read it and told me it was “brave.” I was immediately mortified! Had I done something brave without realizing it? Because I didn’t feel brave. Sometimes, I can get so wrapped up in the intellectual, brainiac experience of writing (like, Look at this beautiful thing I crafted!) that I lose track of how personal the content is. Sometimes, I look at Exploding Head and think, What have I done? But there’s no taking it back now.
Last year, I resolved to return to the personal essay form (after twenty-five years?), and I found myself completely obsessed (in a good way, not in an OCD way). I spent months writing an essay about Metallica’s song “Enter Sandman” and keeping my OCD secret in high school. Many nights I stayed up until 1:30 or 2 a.m. working on it. I’d never written about music before. And that essay ends in joy. I’d never really written about joy before. It was so hard. And it was so. much. fun.
So, I figured, poetry is work, but essays are fun! Until I dove deeply into an essay on gun violence and some of my scariest OCD moments from childhood, and there was that same old torturous feeling of slogging through the draft, and I realized that maybe it was just that writing about joy and music was fun, and not necessarily writing essays.
But essays have opened up a whole new level of vulnerability and storytelling than I’ve ever had room for in poems. For now, I’m focusing on telling more of my OCD stories, but who knows what else might creep into an essay? Recently, when I find myself working on a poem that’s growing longer and longer, I’ve been thinking, instead of cutting ideas out to force brevity and compression, why not expand? So I’m looking forward to exploring what else I can do. And I’m slowly working on my bravery.
EMILY COSTA is the author of Until it Feels Right (Autofocus Books, 2022). Her work can be found in X-R-A-Y, Split Lip, HAD, Wigleaf, and elsewhere. Follow her on Twitter @emilylauracosta.
CYNTHIA MARIE HOFFMAN is the author of Exploding Head (Persea Books, 2024), Call Me When You Want to Talk About the Tombstones (Persea Books, 2018), Paper Doll Fetus (Persea Books, 2014), and Sightseer (Persea Books, 2011). Essays can be found in TIME and The Sun, and poems can be found in Electric Literature, The Believer, The Los Angeles Review, and elsewhere. Find her on Twitter @CynthiaMHoffman.
