Brain Lock: Free Yourself From Obsessive-Compulsive Behavior (9 page)

Although Michael has overcome most of his other obsessions, he says his OCD “seems determined to dig in for all it’s worth and win the final battle,” the battle of the too-tight pants. Or, as Michael somewhat inelegantly puts it, the fear that “my jockey shorts are going up my butt and are going to come through my mouth, they’re shrinking so much.” Before behavior therapy, he would sometimes shed his clothes in an attempt to shed the feeling. Now, he realizes that giving in to a ridiculous thought is the worst thing he could do.

Michael finally overcame his obsession about pesticide contamination, an obsession so severe that “just seeing a can of Raid at the supermarket” traumatized him. “If I’d put my things down for the cashier and somebody ahead of me had a can of Raid, I’d have to take all my food, everything, and put it back on the shelves and restock my basket. I thought everything had been contaminated. Of course, I’d have to go to a different checker because I didn’t know if the conveyor belt was contaminated. Sometimes it would take so long that I would just have to forget about getting food.” If Michael saw an exterminator’s truck on the road, he would have to go home, wash his clothes, and shower. Always, he says, “I felt like this shroud of poison was kind of draped over me.”

The moment of truth came when he was informed that the apartment house where he was living had been sold and the building was to be tented for termite treatment. Michael panicked. Should he protest at city hall? Get a psychiatrist’s note saying that the exterminators couldn’t be allowed in because he was mentally ill? Then he got hold of himself. “I thought, ‘Wait a minute. Just let them do it because maybe I’ll get better.’ I had resolved that this had to be done and that I wasn’t going to die. This was a really big thing for me.” One moment of clarity, after twenty years of suffering from this obsession. The work of using mindful awareness to know what
obsessions really are began to pay off for him in a big way. Michael then went one step further. When the exterminator came, Michael asked him for his business card. He took to carrying the card around as a reminder that he wasn’t going to die. By purposely exposing himself to what once had terrified him, he knew he was making himself better.

Through practicing the Four Steps, Michael has learned to think of OCD as “this bad guy in my brain that can’t fool me anymore. I know I’m not going to die from pesticides. I know I can touch a table twice without touching it a third time” and nothing disastrous is going to happen. But those creeping pants still nag at him. “That’s part of my body. They’re on my skin. They’re there all the time, something I can’t escape.” Although Michael still has a modest amount of residual OCD, he’s well aware of the tremendous amount of improvement he’s made and of how much he has increased his ability to function.

In the battle against OCD, he has learned, “You just do anything you can to sabotage yourself. It takes incredible drive, total effort, to resist it. It’s just intense pain, as bad as any physical pain.” He has learned, too, that robotlike performance of the Four Steps, without mindful awareness, does not work. This is Michael’s description of himself locked in combat with his OCD, practicing self-directed exposure therapy: “You’re thinking, ‘Well, if I touch this, my father’s going to die, but I’m going to do it anyway.’ So you touch it and you
still
feel your father’s going to die. You just have to say to yourself, ‘Okay, whatever happens, it’s better than living this life.’ Just do the Four Steps and keep the faith.” What a deep insight that is! Today, Michael says, he’s “down in the dirt with my OCD.” The smart money won’t bet against someone who can fight like that.

At UCLA, we have many case histories of OCD-related contamination fears. In the case of Jack, a temporary worker, actual physical pain was the impetus for him to seek help for his compulsive hand washing. He couldn’t face another winter with red, raw, cracked hands. He washed his hands so much that his young daughter called them his “soap popsicles”—icy cold with the smell of embedded soap that he could never quite wash away. In treatment, he learned that when he refuses to give in to the urges to wash his hands, noth
ing catastrophic happens. “I know if I don’t do it that it’s not going to be the end of the world.” Before, he always felt as though “catastrophe was just around the corner. My safe places—my car, my home—were all going to be invaded if I didn’t do those compulsions.”

It is not vital that Jack, and other patients, successfully Relabel every time an urge to do a compulsion arises. But if they give in and perform the compulsion, it
is
vital that they recognize mindfully that it is a compulsion and that, this time, they were unable to resist it.
This is much more useful than Relabeling in an offhanded automatic manner
. When you Relabel automatically, it becomes a ritual in itself and has no meaning. There is nothing magical about saying to yourself, “Oh, that’s an obsession.” Following doctor’s orders in that fashion—mechanically, without thinking about what you are doing—is not helpful. Mindful awareness is. So you say, “The feeling is too strong. I don’t have the strength to fight it this time, so I’ll look to see if I locked the door.” Then, when you do check the door, do it carefully, with mindful awareness, so you’ll be ready to fend off the urge next time. You don’t say, “Let me just make sure the door is locked.” That’s a sure prescription for endless compulsive checking.

ASSERTIVE RELABELING

At UCLA, patients are asked to write essays in which they describe their symptoms and how they respond to them—another type of self-directed therapy. These essays have also provided us with an extraordinary library of knowledge on OCD. Since OCD patients tend to be bright, creative people, their ways of expressing what they go through in battling their disease make for fascinating reading.

Joanne, who’d suffered for years from a small voice in her head repeating negative thoughts over and over like a broken record, told of seeking a cure in a self-help book. The author suggested she snap a rubber band on her wrist as a distraction technique whenever her mind started playing its OCD tricks. Joanne wrote, “All I got was a sore wrist the first day.” What eventually made her better was not a rubber band, but the Four Steps. She first began to feel that she had some control over her life when she told herself, “If I don’t want to get hit by the train [the negative obsessive thoughts], I have to get
off the track and let the train go by.” She was applying a technique we call “working around” her OCD. Today, with the help of behavioral therapy and medication, Joanne is able to say, “The sun shines on my soul.”

Mark, a young artist, described a true-life OCD experience that reads like a pilot for a horror film. His OCD started in childhood with prayer rituals and, by his early 20s, had shifted focus to a cleaning compulsion. He would have to clean his apartment twelve times (twelve was a “good” number) and then “find some girl and have sex in order to cosmically sort of switch the energies back the right way,” so a member of his family would not die. Using a woman in that way made him feel bad, so he would clean one more time as a sort of purification ritual. Then, one day, after the thirteenth cleaning of his apartment, he was walking down the street and “a pigeon literally dropped out of the sky, dead at my feet, with blood gurgling out of its beak.” Clearly, this was an evil omen. Thirteen was a bad number; he had to clean a few more times. Having done so, Mark went to a coffee shop for lunch but, as luck would have it, the man in the next booth was reading a newspaper with the headline
WHERE PIGEONS GO TO DIE
. Okay, he thought, let’s clean some more. Finally, after he had cleaned his apartment twenty-one times, he was able to rest easy.

For a time, Mark thought he could fool his OCD by turning the tables on it, saying that if he
did
his compulsions, a family member would die. “I thought, okay, Mr. Smarty Pants. I’ve solved this thing. There you go.” It didn’t work. New compulsions took over. “I hadn’t learned my lesson, which is that you can’t use this shortcut and get to the finish line. It doesn’t work, and it always backfires.” It would be years before he would rid himself of his cleaning compulsion: “There was actually one time when I had to clean my apartment 144 times. It took months.”

For Mark, the breakthrough during behavior therapy came when he found an apartment he wanted but was warned by his inner OCD voice, “No, you shouldn’t move in there.” The numbers in the address were not “good” numbers. Mark took a stand. “Damn it, I can’t believe I’m going to let a choice in my life that’s this major be dictated by OCD.” This is assertive Relabeling. Right after Mark
moved in, his thoughts about “bad numbers” went away. He told himself, as he always does now when OCD thoughts intrude, “I don’t have to do it. I don’t have to do anything about it.”

OCD: A TUMBLEWEED

Lara, who suffers from Tourette’s syndrome as well as classic OCD, describes a plethora of symptoms, ranging from violent thoughts about knives to compulsive shopping sprees. Once, she sought help at Shoppers Anonymous, but quickly learned a basic fact of OCD: Whereas the anonymous compulsive shoppers described getting a rush, a high, from shopping, Lara gains no pleasure from her repeated trips to the mall. She says, “My obsessions are painful. They’re not nice. I’ll buy something I don’t need, and then I’ll return it. I almost get more charge out of returning it than buying it.” Lara’s statement helps to clarify an important difference between OCD and problems with impulse control. As a behavior, OCD in itself is essentially
never
enjoyable.

Lara is also driven crazy by obsessions—the fear of harming herself or someone else, of doing something embarrassing, of planes crashing into her house, or of freeway overpasses toppling on her. “It’s like one obsession propels another that propels another. If you’ve seen the rat on the wheel, that’s what it’s like. Or the teacup ride at Disneyland that spins unforgivingly fast.”

Lara has never acted out a violent thought. People with OCD never do. Through behavior therapy, she has learned to Relabel her thoughts as irrational, to tell herself, “It’s not reality. You’re frightened because it seems so horrific and unbelievable.” She now knows that she can control those thoughts and urges, no matter how strong or disruptive they become. She still battles the obsessions, which she describes as her “added baggage” that she takes everywhere with her and cannot walk away from.

Carla, a beautician, became so obsessed with the idea that she was going to harm her infant daughter that she considered giving up for adoption this child she had wanted so much, for so long. (She was 40 and had been married for fourteen years when her daughter was born.) Carla, who was at first misdiagnosed as having severe postpar
tum depression, would suffer panic attacks—thoughts that she was going to kill the baby—that were so severe that she couldn’t look at a knife or a pair of scissors. “It was like watching a movie where you almost put yourself into that screen and you think, ‘Oh, God, am I capable of committing such an act?’ I was fighting this every day, all day.” Only her determination to take care of her baby’s needs kept her going. She would literally crawl on her hands and knees into the nursery to change the baby’s diapers.

Her daughter is now 6, and Carla thanks God every day that she is around to watch her grow up. There was a long time when her OCD thoughts were so bad that she wanted to be committed, so bad that she thought of taking her own life to spare her daughter’s life. Carla describes OCD as a “tumbleweed” that picks up more and more nonsensical thoughts as it rolls along. But in treatment, she has learned to separate herself from those thoughts. When an OCD thought intrudes, Carla says to herself, “First, my name is Carla and, second, I have OCD. My life is not OCD.” It’s so automatic now, she says, that it’s like writing her name or taking a drink of water. Click! A lightbulb goes off in her head. Her defenses are ready. Mindful awareness and the ability to Relabel arise in a flash to the prepared mind.

Although many people with OCD are loath to tell others they have this problem—either out of embarrassment or of fear of losing their jobs or perhaps because they’ve learned that people just don’t want to hear about it—Carla finds a great sense of relief in sharing her secret with others. She does a great deal of volunteer work, some of it helping people with physical problems. “For me to say, ‘Hey, I have OCD. How can I help you?’—it’s almost like coming out of the closet.” Training your mind to think, “How can I help
you
?”—that’s behavior therapy with a capital B.

“Of course,” Carla says, “I wish there were some super-remedy where I could commit myself to a hospital, have surgery, and come out healthy. But that’s not fact.” Behavior therapy is the next best option, and in some ways it’s even better when it results in a person’s development of mindful awareness.

Now that you have an understanding of Step 1: Relabeling—calling OCD what it really is—I will introduce you to the Reattributing step. In essence, Reattributing is nothing more than placing the
blame for OCD symptoms squarely where it belongs—with your sticky brain.

Reattributing answers those nagging questions, “
Why is this thing bothering me so much? Why doesn’t it go away?
”

OCD doesn’t go away because it is a medical condition. Someone with Parkinson’s disease may decide, “Oh, I’m no damned good. Why can’t I move at the same speed as everybody else?” The person with Parkinson’s has to regroup, to say, “Because I have a medical condition. I must adjust to this condition.” You must adjust to the condition called OCD and maximize your function. You’re not a victim. You’re working on a problem.

KEY POINTS TO REMEMBER

• Step 1 is the Relabel step.

• Relabel means calling the intrusive unwanted thoughts and behaviors what they
really are:
obsessions and compulsions.

• Relabeling won’t make unwanted thoughts and urges go away immediately, but it will prepare you to change your behavioral responses.