Brain Lock: Free Yourself From Obsessive-Compulsive Behavior (3 page)

Once people learn to perform the Four Steps on a regular basis, two very positive things happen. First, they gain better control over their behavioral responses to their thoughts and feelings, which, in turn, makes day-to-day living much happier and healthier. Second, by altering their behavioral responses, they change the faulty brain chemistry that was causing the intense discomfort of their OCD symptoms. Since it has been scientifically demonstrated that the brain chemistry in this serious psychiatric condition is changed through the practice of the Four Steps, it is likely that one could also change one’s brain chemistry by altering responses to any number of other behaviors or bad habits through
using the Four Steps. The result could be a lessening of the intensity and intrusiveness of these unwanted habits and behaviors, making them easier to break.

WHAT’S OCD, WHAT ISN’T?

Because of the similarity in names, people tend to confuse the term
obsessive-compulsive disorder
with the far less disabling
obsessive-compulsive personality disorder
(OCPD). What sets them apart? Simply stated, when your obsessions and compulsions are bad enough to cause significant functional impairment, you have OCD. In OCPD, these “obsessions” and “compulsions” are more like personality quirks or idiosyncrasies, however unpleasant. For example, a man with OCPD may hang on to some object because he believes he may need it someday. But a man with an OCD hoarding compulsion may fill every square foot of his house with worthless trash he knows he’ll never need. People with OCPD tend to have trouble “seeing the forest for the trees.” Typically, they are list makers who get so hung up on details that they never get around to seeing the big picture. Their quest for perfection interferes with their getting things done. OCPD is a classic case of the “best” being the “enemy of the good.” People with OCPD tend to mess up things that are good enough in their quest to make everything “perfect in every detail.” They are often totally inflexible, unable to compromise. In their view, if a job is to be done right, it must be done their way. They are unwilling to delegate. It is interesting that this personality type is twice as common in males, whereas OCD does not discriminate between sexes.

The other crucial difference between OCD and OCPD is that although people with OCPD are rigid and stubborn and let their ideas run their lives,
they have no real desire to change their ways
. Either they are not aware that their behavior annoys others or they simply don’t care. The person with OCD washes and washes, even though it causes him great pain and gives him no pleasure. The person with OCPD
enjoys
washing and cleaning and thinks, “If everyone cleaned as much as I do, everything would be fine. The problem is that my family is a bunch of slobs.” The person with OCPD may
look forward to going home at night and lining up all her pencils on her desktop like little soldiers. The person with OCD dreads going home, knowing she will give in to that false message telling her to vacuum twenty times. Unlike people with OCPD, those with OCD realize how inappropriate their behavior is, are ashamed and embarrassed by it, and are in the truest sense desperate to change their behavior. In the words of two people with OCD, “My brain had become an indescribable hell from which I could not escape,” and “It’s a good thing the windows in the hospital were bolted because I was ready to take the short way out.”

This book is mainly about people with OCD. Most of the stories are about their struggles to overcome their disease. But millions of people with less crippling problems can take inspiration from these stories and learn a self-treatment method that can be applied to a wide variety of troublesome behaviors. Those who shared their stories are people who overcame a medical illness. The method they used can be learned and can benefit almost anyone. This book is for all those who want to change their behaviors and are seeking the tools that will help them do so.

THE WAY WE WERE: SIX CASE STUDIES

Here are the stories of some who were totally overwhelmed by OCD when we first met them, but have managed to overcome this dreadful opponent. The symptoms they describe are not rare and obscure; they are extremely common symptoms of this disease.

JACK

Jack, a 43-year-old insurance examiner, washed his hands at least fifty times a day—a hundred or more times on a bad-hands day. There was so much soap embedded in his skin that he could lather up just by wetting his hands. He knew his hands weren’t dirty, just as he knew that everything he touched wasn’t then magically contaminated. If there were some kind of mass contamination, he reasoned, “People would be dropping like flies.” But he just couldn’t get over the
feeling
that his hands were dirty, so he washed and washed, constantly worrying, “Did I really wash my hands? Did I wash them right?” His hands became so raw and red that big cracks opened between his fingers. Just a splash of water on his skin was like pouring salt in an open wound. But Jack kept on washing. He couldn’t stop himself. It was his terrible secret, one he covered up with ploys that a secret agent would admire.

BARBARA

Barbara, a 33-year-old honors graduate of a prestigious Ivy League university, knew that she was an underachiever, working for a temporary agency. She was intelligent and articulate, but was plagued by intrusive thoughts that told her to check and recheck things. Had she unplugged the appliances? Locked the door? Often, she would leave early for her job, knowing she
would have to turn around and come back home once or twice to check. One really bad day, she tucked the coffee machine and the iron in her book bag and took them to work. She felt very ashamed. “If you start doing these things,” Barbara told herself, “you’re going to lose whatever self-respect you have left.” So she developed new strategies for coping with her nagging and nonsensical thoughts: Before she left for work each day, she put the coffee machine on top of the refrigerator, far from any electrical outlet, and said out loud—and very tongue in cheek—“Goodbye, Mr. Coffee!” She had come up with a mnemonic device to help her remember that she had unplugged it. She would also press the prongs of the plug on her iron into her palm, leaving deep marks that she could still see thirty minutes later to reassure herself that she had unplugged the iron.

BRIAN

Brian, a 46-year-old car salesman, lay awake in bed every night, listening for the wail of sirens. If he heard both a fire engine and a police car, he knew there’d been a traffic accident nearby. Whatever the hour, he would get up, dress, and drive around until he found the accident scene. As soon as the police had left, he’d take a bucket of water, a brush, and baking soda from his car and start scrubbing down the asphalt. He had to. Battery acid might have spilled in the collision, and Brian, who had to drive these streets every day, had a morbid fear of being contaminated by battery acid. Once he’d finished scrubbing—it might be 3
A.M.
—he’d drive home, shower, put his tennis shoes in a plastic bag, and toss the bag into the trash can. He bought his shoes on sale, a dozen or more pairs at a time, knowing he could wear them only one night.

DOTTIE

Dottie, aged 52, had been battling obsessions since she was 5. One obsession was a fear of any number that included a five or
a six. If, while driving with a friend, she spotted a car with a five or six on its license plate, she would have to pull over and wait for a car with a “lucky” number to pass. “We could sit there for hours,” she remembers. But she just knew that otherwise something terrible was going to happen to her mother. When Dottie became a mother herself, her obsessions shifted to her son and became even more bizarre. “It was eyes,” she said. “All of a sudden I got it into my head that if I did everything right, my son’s eyes would be all right and mine would be all right.” Neither Dottie nor her son had eye problems; still, she couldn’t bear to be around anyone who did. “Just the word
ophthalmologist
would bring in very bad thoughts. I could never step where a person who couldn’t see properly had walked. I’d have to throw away my shoes.” As Dottie and I talked, I noticed that she had written the word
vision
four times in the palm of one hand. She explained that while watching TV that afternoon, she’d had a bad thought about eyes and had tried to exorcise it.

LARA

Lara described her obsessions this way: “They tear at my soul. One little thought, and the obsessions explode into a fireball, a monster that is out of control.” It was knives that made her life hell. “It could be a butter knife, but when I picked it up I wanted to stab someone, especially someone who was close to me. It was horrible. God, I would never hurt anyone! The scariest for me was when I had these obsessions toward my husband.”

ROBERTA

Roberta would drive over a bump or a pothole and suddenly panic, imagining that she’d hit someone. Once, pulling out of a shopping mall, she spotted a plastic bag in the parking lot. “In a flash, something was telling me it was a body. I stopped and stared at it, knowing that it was just a plastic bag. But the fear and panic began. I drove around to look at it again….” Wherever she went, she would look in the rearview mirror, her stomach in knots. Was that just a newspaper at the side of the road? Or was it a body? Terrified to drive, she became a prisoner in her own house.

THE BALKY BRAIN

As a research psychiatrist at UCLA School of Medicine, I have treated more than one thousand people with OCD in the past decade, both one-on-one and in a unique weekly OCD therapy group. The vast majority of them are much more functional and more comfortable as a result of practicing the Four-Step Self-Treatment Method. Some of them also take modest amounts of medication, finding it improves their ability to do the work required in therapy.

Our UCLA team came to the study of OCD as an offshoot of studying depression. We had noted specific brain changes in depressed patients, and, knowing that many people with OCD also suffer from depression, we wondered if OCD patients also undergo brain changes. So, we placed an ad in a local newspaper asking, “Do you have repetitive thoughts, rituals you can’t control?” We hoped to find a handful of respondents who would be willing to come to the UCLA Neuropsychiatric Institute to have a positron emission tomography (PET) scan, which measures the metabolic activity of the brain. To our astonishment, the response was overwhelming. Clearly, OCD was more prevalent than we thought. And when we did PET scans of these people’s brains, we could actually see changes related to their OCD.

Over ten years, I’ve learned a great deal about people, their courage, their will to survive and improve, and their ability to change and control their responses to the false messages that come from their brains as a result of OCD.

Until relatively recently, there was little that doctors could do for people with OCD. Sigmund Freud and his followers believed that these obsessions and compulsions are caused by deep-seated, emotional conflicts. Patients often tell us about years of misdiagnosis by well-meaning therapists. Brian recalled one psychotherapist telling him that his fear of battery acid had sexual implications and suggesting that perhaps he had been molested by his father. That was when Brian sought help at UCLA.

WORRYING ABOUT WORRYING

From a doctor’s perspective, the biggest problem that people with OCD face is how much they worry about how worried they are.
What really troubles them is how anxious they get about things they realize aren’t worth worrying about. When we begin to understand the extent of this mental anguish, we can begin to understand some deep truths about the relationship between a person and his or her brain.

One way to understand this relationship is to know the difference between the
form
of obsessive-compulsive disorder and its
content
.

When a doctor first asks, “What exactly is bothering you?” most people with OCD say something like “I can’t stop worrying about my hands being dirty.” But a doctor who’s treated a number of persons with OCD knows that this is not the real problem. The real problem is that no matter what they do in response to what’s worrying them, the urge to check or to wash will not go away. This is what is meant by the
form
of OCD: Thoughts and urges that don’t really make sense keep intruding into a person’s mind in an unrelenting barrage. Together with many other brain scientists, our UCLA team believes that OCD is a brain disease, in essence a neurological problem. The thought does not go away because the brain is not working properly. So OCD is primarily a biological problem, tied to faulty chemical wiring in the brain. The form of OCD—the unrelenting intrusiveness and the fact that these thoughts keep reoccurring—is caused by a biochemical imbalance in the brain that may be genetically inherited.

The
content—
why one person feels something is dirty while another can’t stop worrying that the door is unlocked—may well be attributable to emotional factors in a person’s background and family circumstances, as traditionally understood by Freudian psychiatry. Whatever the reason, there is no biological explanation for why one person washes and another checks, but OCD is truly a neuropsychiatric disease: Its hallmark symptom—intrusive thoughts and worries—is almost certainly caused by a problem in the brain. But, of course, having a problem like that brings with it significant emotional upset and personal insecurity. And the stresses of these emotional responses can actually intensify the brain-related difficulty. In this book you’ll learn to deal with both sets of problems.

TAKING CHARGE