Brain Lock: Free Yourself From Obsessive-Compulsive Behavior (23 page)

In retrospect, Michael wishes he had felt free to tell his parents about his crazy thoughts. “But,” he says, “I’m sure my parents would have sent me to an institution, where it wouldn’t have been understood what was going on…. To this day, my father doesn’t really understand. I don’t think mental illness is included in his vocabulary.” (Michael is probably right; little was known about OCD thirty-five years ago, and many people still don’t understand it.)

Michael yearned to communicate to his parents what he was experiencing, yet he never could. “All my life,” he says, “I was just wanting someone to say, ‘I’m sorry. I wish things were better. I realize you try.’” But because he never heard these words, he never felt fully loved or fully accepted—and he learned to bottle up his own feelings. As he has grown older, that trait has worsened. “One thing I see in common with people with OCD is that their feelings get numb. When I get into a relationship, I immediately close down my feelings and really sabotage myself. And that’s when the OCD will be the strongest. At the moment you want to really feel something, all you feel is the OCD.”

OCD-fueled fears can be much stronger than any other emotions, including love and grief. For instance, an elderly woman in the UCLA OCD therapy group has a death-related obsession that is so strong that she cannot with comfort go anyplace where people have died, even centuries before. A family vacation to Tombstone, Arizona was traumatic for her. Everything she had worn there or taken with her became contaminated. She has alienated herself from dear friends because they can’t understand her silence when they lose loved ones. But she cannot bear to pay condolence calls or even to pick up the telephone and say how sorry she is. She rationalized that by this avoidance she was keeping her anxiety level low, even at the
risk of losing friends. That’s not very clear thinking, though it’s understandable that someone would be willing to make that tradeoff. In reality, it’s not a true tradeoff. By not making condolence calls, she is just setting herself up for her intense obsessional fear to worsen and worsen. If her fear is to go away, she must confront it. Another woman was unable to say good-bye to her father as he lay dying because compulsions prevented her from leaving her house to get to the hospital on time.

Recently, things have turned around for Michael, who has faithfully practiced the Four Steps, reinforced by regular attendance at the OCD therapy group at UCLA. For years, he had used medication to bolster therapy, but he came to believe that “medication was really leveling out my personality. I was just very numb. My feelings were very much kept in check. In order to fight their OCD, people have to really let their feelings go.”

Although his OCD was largely under control, Michael felt that he had reached a plateau, and he wanted to do better. Therefore, he decided to go off the medication and felt better almost as soon as he did. Although he has experienced some escalation of his OCD thoughts and urges since then, he uses the Four Steps to effectively control them. “I’m going downhill now, rather than fighting my way uphill, caught on the treadmill of OCD.” And, for the first time in years, he is experiencing deep emotions. He remembers, “When my mother died a few years ago, I didn’t cry at all.” Again, that numbness. “But when my favorite baseball player, Mickey Mantle, died”—this was after Michael went off the medication—“I was hurt very badly and I cried and was able to let out my feelings.” When he is able to do so, he finds that his OCD level is very low, whereas when he suppresses his feelings his OCD is at its worst.

The isolation felt by people with OCD is largely the result of their decision to keep their terrible secret from others as long as they can. Michael, on the other hand, likes to tell people that he has OCD—“It’s a very liberating feeling, a real catharsis. You know, ‘Hey! I’m crazy. How are you?’” But he has also learned that most people either don’t care to know about his problem or react by bombarding him with a list of physical or mental, symptoms of their own.

TO TELL OR NOT TO TELL

Barbara, who obsessed about whether she had unplugged Mr. Coffee, told everyone when she was first diagnosed, figuring that “if people knew the very worst about me and still thought I was okay, then I was okay.” But she quickly learned to keep quiet about her OCD. At work, people would respond either by making jokes at her expense or looking perplexed and responding, “Why don’t you just stop it?” Barbara realized that being forthright about OCD was a bad career move. Unfortunately, that is all too frequently the case.

Benjamin, who once had to live in a totally organized environment, says, “I don’t see anything productive about telling people I don’t have to tell because of people’s general lack of understanding about mental disorders.” He doesn’t tell work associates or new friends, for example. But he has been open with his girlfriend and with his family, and both have responded positively. The decision to be honest with his family was a tough one: “Because I come from a highly successful family, high-powered people who were successful socially and professionally, I had sort of built this brick wall around myself” in an effort to hide this defect from them. Telling them about his OCD was “a great relief. After I opened up, they opened up much more. It had a positive snowballing effect. Their response was much more empathic and understanding than I had anticipated. I no longer have to carry around this big defense. I’m a much more open person, more able to admit other weaknesses and to laugh at myself.”

He learned that “people respect other people for accepting themselves for what and who they are. And people do have a high level of tolerance for a physical disorder—if they see that the person is trying to function and interact as well as he can.”

Benjamin has observed that others can sense in people with OCD a preoccupation and lack of spontaneity that inhibits intimacy. As he gets his OCD more under control and is less preoccupied with himself, he hopes to expand his social contacts. “I know I’ve got to step around the OCD. I’ve got to function like other people do. I have a responsibility toward other people. I am constantly evaluating myself: Is it my OCD that’s keeping me from being a loving person,
a person who can have an impact on other people’s lives? A person who can be helpful, caring, more empathic?”

Not everyone, of course, has had as positive an experience. Christopher found that his parents never really understood his OCD and just counseled him to try to “think good thoughts all the time.” This lack of understanding led to tense encounters with his father whenever the subject came up. “I was actually forced at one point to quit seeing a doctor because I supposedly didn’t really have a problem and the ‘psychiatric stuff’ had gone on long enough.” Several months later, Christopher persuaded his parents to allow him to go into the OCD program at UCLA, where I introduced him to our Four-Step program. He continues to make progress and is a regular in our OCD therapy group.

OCD patients frequently talk about having OCD personalities, of being extremely introverted, afraid of aggression, and unable to deal with aggressive people. Jack, the compulsive hand washer, has bounced from job to job and has learned, “I really don’t like dealing with people that much. Those seem to be the jobs I do the absolute worst in. I had a summer job as a bank teller, and it was terrible. Customers demanded speed and friendliness, while I was just concentrating on what I was supposed to do. I was definitely not the friendly bank teller.” He also taught school for a while. “Can you imagine? At the high school level, it’s all assertiveness and discipline.” Not Jack’s strong suits.

USING COMPULSIONS TO CONTROL

In an interview for this book, Dr. Iver Hand confirmed that those with clinical cases of OCD may tend to settle into menial, undemanding jobs. “People with OCD can be pretty successful” at the right job, he said, “like being a mechanic or a computer programmer. Their OCD can actually help them do a good job. But if they get a promotion, they have no skills to lead. They don’t know how to handle competition problems. Within a very few months, people who, from their point of view, were pretty happy with their professional lives completely overcompensate and develop compulsions that make them absolutely unable to go to work.”

Undoubtedly, environmental and genetic factors both play some role in the development of OCD. Several people with OCD have told me that they grew up in households headed by either a very rigid father or a dominating mother (which, of course, could be the result of the parent having undiagnosed OCD) and that they believe this background contributed to their having very low self-esteem. To compensate, Dr. Hand found, these people may develop controlling compulsions. “They have to be perfect” as a way of controlling their social environment. Still, he said, “Nobody knows why some people who have grown up under these conditions later develop OCD and others don’t, or develop other disorders.” Nevertheless, the scientific evidence for a biological pattern of genetic inheritance has grown quite strong.

Low self-esteem can set people up for failure. A man with OCD, for example, who tells himself, “I’ll never get married because no one will deal with this stuff,” creates a self-fulfilling prophecy, cuts himself off from social outlets, and ends up alone.

It is clear that many people with low self-esteem grow up to have latent aggressive personalities. They are insecure, even if they manage to function passably well both socially and professionally, but they lack real social skills and distrust those around them. In a marriage, if they have the biological predisposition, they may develop obsessive-compulsive behaviors to control their spouses. Or in self-defense, a child who grows up in an emotionally tumultuous environment may develop OCD as a counter-weapon. “They build up their own safe little world,” Hand noted.

Sometimes, but not always, Hand said, children will respond with hatred. They may seek affection elsewhere, perhaps from their peers. In interviews with OCD families, he sees a lot of anger and aggression among the members. “It’s horrible, frightening—the whole family, one after another, will say they had thoughts of killing the other one.” The OCD plays a role, certainly, but it may not be the major one, and the real, underlying problems come out during treatment.

LOOKING FOR LOVE

When a parent has OCD, a child may grow up harboring fierce anger and resentment for having been denied a “normal” life, having
had to participate in the parent’s bizarre and time-consuming rituals. Dottie, who washed excessively to try to rid herself of the fear that something would happen to her son’s eyes, explained to him when he was old enough that she had an illness called OCD and that she did crazy things because she could not help herself. But when he went off to college, he upset her greatly by saying, “I’ve had enough of you, Mom.” A single parent, she had done everything she could for him to try to make up for the turmoil she created. “I thought I was a good mother, but a couple of years ago he told me, ‘I thought you were the most terrible mother there was.’ If someone had taken a knife and stabbed me…I mean, that was the worst thing anyone’s ever said to me, ever. Whether he really understands or not, of course, it doesn’t matter now. I did the best I could.”

The story of Karen, the compulsive hoarder in our UCLA group, is a strong argument for the role of both environment and genetics in the development of OCD. Karen’s father demanded perfection of everyone else in the household, though he was far from perfect himself. Without doubt, he had classic OCD—checking and contamination obsessions and an over-the-edge compulsiveness about not wasting anything. Karen actually “learned” OCD at his knee. He showed her how to check the knobs on the stove just so and lectured her about the dangers of bacteria and viruses. She recalls, “Taking care of a splinter was practically like performing surgery. There was this whole routine to make sure no infection developed.” If Karen failed to carry out one of his orders, his face would contort with rage, and she knew a beating was coming. Desperately seeking his love and approval, she found ways to get them. He insisted that the family buy everything secondhand, usually at church rummage sales, and he would take Karen to the city dump to pick up junk that he would fix up or make something out of. Karen took to salvaging items from trash cans in alleys and bringing them home. Her finds always resulted in a pat on the head. Karen says, “In my middle age, these ideas and values of my early years came back to haunt me—and very nearly ruined my life.”

Most of the time, Karen compensated for the lack of affection at home by being a “good girl,” getting all A’s at school and obeying her father’s ridiculous demands. Still, he never let up on her. One
day she exploded to her mother, “I hate his guts!” Certain that he had heard her, she dreaded coming home from school that day to face the consequences. When she walked in, she found him lying dead on the kitchen floor. He had had a heart attack. Karen says, “I was 15 years old. I felt I had killed my father as surely as if I had held a gun to his chest and pulled the trigger.” From then on, she strove even harder to be perfect, reasoning that somehow her father would know and that would make things right between them. Her quest for perfection proved costly. She developed anorexia nervosa and a binge-and-starve eating compulsion and wound up in a psychiatric hospital the day of her high school graduation, where she was to have been honored as the girl with the highest grade-point average.

Children often respond quickly to therapy. An 11-year-old girl with no history of psychiatric illness developed obsessions and compulsions after experiencing her first earthquake soon after the family moved to southern California. She obsessed that her parents would be injured or that she would be separated from them. (There was some logical basis for her fears because the family’s home was near the epicenter and sustained some damage.) The child developed sleep disorders and compulsive behaviors. Whereas she had once been a typically messy 11-year-old, she began arranging her desk and belongings just so. She devised a ritual whereby for thirty minutes at bedtime she would have to write on an inkboard, “Nothing is going to happen to Mommy and Daddy.” She also brought a glass of water to her bedside each night, convinced that it would keep her mother, her father, and her rabbit safe. Since the child’s father is a psychiatrist, he immediately recognized that she had a problem, and the family sought professional help five weeks after the behaviors began. In therapy, the therapist told the girl that she was developing a disorder called OCD and explained what it is and what it does. The girl was also told that she must resist her compulsions or they would only get worse. After three months of treatment, her symptoms had virtually disappeared. Less aware parents might have continued to cater to the child’s OCD, thinking it was a passing phase, and OCD could have dug in and eventually thrown the family into emotional chaos.