Brain Lock: Free Yourself From Obsessive-Compulsive Behavior (24 page)

A SHARED SICKNESS

Frequently, family members will accommodate the person with OCD to an absurd degree—Karen’s husband, for example, allowed the junk to pile up in their house until they had only a narrow path that was navigable. It had been years since they had allowed people in. Still, he tolerated her bizarre behavior. Was he himself sick? Dr. Hand thinks so. “Only people with their own severe psychological problems,” he believes, would let such a situation get absurdly out of hand. He mentioned a case of a couple who moved six or seven times, thinking that things would be different in a new home, but it never took long for the new place to become filled with junk.

Hand insists that the family be involved in the diagnosis but allows them to decide on the degree of their involvement in therapy. The person with OCD may be very artful in covering up whatever other problems he or she has—such as difficulty in one-on-one relationships—and may resist too much delving by the therapist. “They are afraid,” Hand stated. “They develop an attitude of learned helplessness. They have their problems, but those problems cannot be solved. If they’re in a stable relationship, the relationship is usually sick as long as they have their OCD. Both sides have no hope that any real improvement is possible but, at the same time, they are very, very scared to disrupt everything. So they prefer to live in bad relationships.”

What Hand calls “interactional dynamite” often develops in families. This term means that the person with OCD harbors long-term aggressions and at crucial, and inappropriate, times uses the OCD to attack his or her spouse for some real or perceived violation of their relationship. Thus, a “sudden outburst” of very intense compulsive behaviors can occur, causing chaos that disrupts the lives of other family members, with the resulting distress and aggravation.

Hand related some case histories from his practice in Hamburg, Germany: One woman who lives with her daughter and son-in-law constantly nagged her daughter about her house not being clean enough. Ultimately, the daughter developed a defensive compulsion. When making the beds, she spent hours and hours smoothing the sheets just so and increasingly neglected the rest of the house. When the mother tried to break her daughter of this habit, the two fought
and the mother threatened to have a heart attack. In reality, Hand found, this was just the culminating battle in a long-standing war for dominance. The power struggle, in which the mother insisted that the daughter be a better housewife, developed into a paradox in which the daughter used her compulsions to get the upper hand.

Another woman became obsessed with her belief that twenty years earlier, her husband had an affair. When she confronted him, calling him a “dirty pig,” he denied it. Ultimately, she was hospitalized with pathological symptoms of jealousy. When she returned home, she developed a massive cleaning compulsion that resulted in 80 percent of the house becoming virtually uninhabitable because in sixteen hours a day of furious cleaning, she could get only 20 percent of the house “clean enough.” When her husband came home from work, she demanded that he undress, and she would bathe and disinfect him from head to toe. Her rationale was that the long-ago affair had made him dirty, and though she could not rid him of that inner dirt, she
could
rid him of his outer dirt. This gave her a feeling of control. In therapy, it came out that what consumed her even more than the suspected affair was the fact that her 6-year-old daughter, her favorite child, had continued to show open affection toward her “errant” father. The woman improved and stopped her cleaning rituals, but she said that she was forced to stop only because she had developed arthritis in her knees, a diagnosis that was never confirmed. She even persuaded her husband to join a dance group with her: The exercise, she explained, would be good for her arthritis.

Still another case was a husband who had a compelling need to repeat simple sentences over and over for hours at a time. He had to do so in front of his wife, so she could assure him that he had correctly pronounced all the words in each sentence and that his voice had the proper intonation. When his wife tried to wiggle out of this chore, he would lock the doors. Finally, he took to locking her inside the bathroom while he stood outside the door, repeating his sentences. Hoping for release, she would occasionally shout through the door, “Good!” or “Correct!” This only aggravated him further because he figured she was not being honest with him. One day, the wife managed to escape from the house, get into her car, and pull out of the driveway. Just then, her husband rushed into the street,
flung himself in front of the car, and forced her to stop. He won.

In treatment, Hand tells patients that they must work out the advantages and disadvantages of clinging to their OCD. If they are in therapy not because
they
want to be—but because someone forced them into it—he believes treatment is futile. And, he added, the therapist and person should work together to develop behavior therapy strategies. For example, the housewife who gets even with her husband by developing cleaning compulsions might be told how their relationship could be reorganized so she could get the same power benefits without the OCD behavior. This technique can be thought of as a broadening of the application of the Reattribute step—it is not
only
the brain that is causing a person to be plagued by OCD symptoms, but the fact that OCD is being used as a mechanism to manipulate others in his or her interpersonal life. This is the “secondary gain” element of OCD symptoms, and the Reattribute step can be used to actively address it and begin to deal with it. By recognizing the role OCD can play in your emotional life, you can make the healthy changes that decrease your tendency to use OCD symptoms in this ultimately self-defeating way. This is another example of how the Four Steps can be used to help enhance the process of better managing the OCD.

UNDERSTANDING, NOT PAMPERING

Let me assure you that it is not true that OCD and healthy marriages and relationships always go together like oil and water. There are cases of couples working together using the Four-Step program to build stable, loving, and supportive relationships.

But the obstacles that OCD can throw in their path should not be negated. People with the disorder may develop sexual anxieties linked to the fear of losing control. One person may have violent thoughts that he or she will never act out, while another may obsess that some wild and uncontrollable sexuality will be unleashed. The person with OCD may take out latent aggressions by initiating conflicts, often involving OCD symptoms, that result in the avoidance of intimacy. Deep down, the motivation may be to avoid the risk of being hurt by opening up emotionally—the old self-esteem issue.

Another case related by Dr. Hand was a teenage boy who developed bizarre food behaviors. He could eat only one thing—a rare and costly fish—and had to be fed by his mother in a ritualistic fashion. His parents were allowed to talk to one another only in his presence and only on topics he chose. He regressed in some areas to age 2 and began dirtying his bed at night. Significantly, all these symptoms came on after the father threatened to have an affair and break up the marriage. The boy achieved what he wanted: When he got sick, his father broke off the affair. The boy, however, became sicker and sicker, withdrawing from his teenage friends and from the outside world. A vicious circle developed: The father came back home, but the marriage was a marriage in name only, with no mutual affection. The mother now took care of her emotional needs by devoting herself to her son, enabling his OCD to escalate. The boy used his illness to dominate his parents. He kept the family together, but at his own expense. They were all together—and all sick. This story did not having a happy ending. The boy improved greatly in family treatment but later relapsed. The social deficits he had developed proved to be disastrous when he tried to reconnect with his peers. His mother lapsed back into her old enabler role. It was family business as usual.

Finally, a woman came to Dr. Hand seeking help after her neighbors complained that she made too much noise when she unlocked the door to her apartment; she explained that she just wanted to know how to calm the neighbors. In therapy, she began to talk about her compulsive Bible translating. As a young woman, she had joined a monastery, eager to withdraw from normal social contacts. She gave the monks a chunk of inherited money, but when she left, disillusioned, a year later, they refused to give back the money. Soon afterward, she began translating the Bible, intent on showing the pope that all existing translations were in error, since they had provided the ethical guidelines for the monks who had treated her badly. Bible translation became her sole mission in life. A part-time secretary, she lived like a nun in her apartment, translating and translating, sending her work to the pope, but her compulsions betrayed her. Instead of getting even with the monks, she developed bizarre behaviors that became her only purpose in a lonely life.

FORGIVING OCD TOGETHER

When families work together, however, wonderful things can result. One patient told me that she got better with her husband’s help: “Together we forgave my OCD.”

Lara, who has violent thoughts about knives, says that she tends to withdraw when she is obsessing, to become quiet, sullen, sad. Her husband will say, “Lara, stop obsessing. I can see the wheels turning in your head. Stop it.” This Relabeling helps snap her back to reality. He gets upset, she says, only because the OCD causes her so much pain. And he is protective. “If there’s a horrible accident on TV, like a plane crash, well, he knows I’m kind of drawn to catastrophic things, so he’ll say, ‘You don’t have to watch that. You’re already afraid of flying’”—another reality check. She has found him to be caring and understanding, and he does not let her OCD frighten him. Sometimes, though, it frightens her in hard-to-explain ways. She and her husband have talked of adopting a baby, but Lara obsesses that the adopted child—who, of course, as yet has neither a name nor a face—will come to harm. “I have a gnawing, pulling, tearing sensation that the child will always be in danger—have an accident, become ill, get kidnapped, or die.” Therefore, the adoption decision has been put on hold.

Carla, who obsessed that she might kill her infant daughter, struggled with intimacy problems in her marriage. “That was the last thing I could think about. OCD takes twenty-four hours a day. I was just trying to survive and function. It was very difficult for him to understand our relationship, and how I had changed.” Before OCD, she had been the superefficient wonder woman, easily coping with her job, volunteer work, and caring for frail parents. With OCD, she could no longer juggle everything and became very frustrated, taking her frustration out partly on her husband. He was puzzled because in fourteen years of marriage, she had always been a take-charge person. Now, she was demanding time off to take care of her own needs, and he wasn’t used to it. “Unfortunately, I didn’t have time to deal with what was going on with me and with him, too. And I didn’t really share what was going on in my head. The details were too scary.”

Family members can be most helpful by offering support, under
standing, kindness, patience, and encouragement in doing the Four Steps—but not by pampering or indulging the person’s OCD. Reinforcement is essential; every improvement should be recognized. People with OCD need to feel good about themselves, since it’s been a long time since they’ve done so. What they don’t need is angry criticism; they are already critical enough of themselves. Nor should they be pushed too fast to get well; their goal will be reached by taking a lot of small steps, not giant leaps. Sure, there will be times when the partner is tired and out of patience with OCD and needs his or her own time out. That’s okay, too. There should be no guilt feelings about that—in fact, the person with OCD should encourage it.

Jack, the hand washer, and his wife had some rough spots in their marriage before he sought help. Both she and their daughter were fed up with his continually asking, “Did you wash your hands?” He understands now, “It was like telling someone they’re dirty.” His OCD-warped mind kept thinking that she was somehow going to contaminate the meals she fixed for them, and the thought almost drove him crazy. But he forced himself to stop asking her if she had washed her hands. “It still bothered me, but I figured that if I kept on, it would create a worse catastrophe—like my wife leaving me.” Insights like this can be great motivators for doing the Four Steps.

In treatment, Jack mentioned his frustration that his family didn’t seem to notice how he was improving, that they wanted the OCD to be gone right away. His wife would say, “I know what you’re doing and why you’re doing it, but it’s still driving me crazy.” Before he was diagnosed, she would get angry with him, telling him his hands were going to fall off if he didn’t stop washing, but she just thought he was a little weird. He laughs and says, “Once there’s a diagnosis, once this thing has a name, people know they can bug you about what you’re doing. Before, they don’t know what the heck is going on and they don’t want to ask questions.” He asks, “Can you imagine living with someone who wants to change you all the time, every waking moment? ‘You know why you’re doing that.’ ‘What are you doing in the bathroom?’ ‘Why are you washing again?’ It would drive me crazy, so after a while she took the attitude that I was getting professional help and she sort of laid off. Once she started crying and said, ‘I wish I could help you.’ I told her she was, by being intolerant of my OCD, by not indulging me
and just making the OCD worse.” Of course, there are better and worse ways for family members to be “intolerant” of OCD.

Jack’s wife drew the line at going with him to group therapy. She’d say, “Why do I want to go see people doing what you’re doing?” He didn’t push her. “I think a little fear had crept in, too. Before, she’d thought these were just my quirks. But suddenly I had a mental disorder. She didn’t want to think about that.”