Brain Lock: Free Yourself From Obsessive-Compulsive Behavior (7 page)

In
Howard Hughes: The Untold Story
, Peter H. Brown and Pat Broeske provide more evidence that Hughes’s obsession about germs and contamination caused him to act in irrational ways. We now know that his actions only served to make his symptoms worse. For a period of time, Hughes weekly invited his friends, underworld figures Lucky Luciano and Bugsy Siegel, to dinner. Because he was obsessed with the idea that gangsters had germs, he kept in a cabinet a set of special china for these occasions. This china could be used only once. At one time, Hughes shared a house in Los Angeles with Katharine Hepburn and Gary Grant. One evening, having come upon the housekeeper smashing the dinner plates, Hepburn confronted Hughes: “This is stupid! People can’t spread germs like this.” Hughes was not convinced. Furthermore, he told Hepburn,
“As a woman who takes eighteen showers a day, I don’t think you’re in a position to argue with me.”

It is possible that Hepburn, too, was afflicted with OCD. We do know that it is not unusual for people with OCD to be attracted to one another. First of all, it’s comforting to find another who understands the agony, who hears the inner voice asking, “Why do I do all these weird things?” People with OCD know that they do things that are a little strange. So, it can be comforting to know others who also do these things. At UCLA, we started the first OCD behavior therapy group in the country. This group still meets weekly at UCLA; it’s a place where people with OCD feel free to divulge their most bizarre thoughts and behaviors and to exchange self-therapy techniques they may have developed on their own. (The Four-Step Method allows for a lot of personal creativity.) At first, there was some concern that these sessions might prove counterproductive, since in some well-intentioned victim-support groups, participants get into a sort of sick competition about who has suffered the most. Also, several patients expressed to me their fear that, through the power of suggestion, they might develop new symptoms to pile onto their existing ones. Neither of these fears has proved true in the nearly ten years the group has been meeting.

One of the many success stories in the OCD group is Domingo, a onetime plumber who is now a self-taught art dealer. Domingo, who was diagnosed with OCD in his native Mexico, was “all the way at the bottom” of the OCD heap when he came to UCLA for treatment. Over a fifteen-year period, his symptoms have included showering five or more hours a day, the fear of showering, checking and eating rituals, and—what is the most bizarre—an obsession that he had razor blades attached to his fingernails. This last obsession led to his reluctance to wear certain clothes, including a favorite vintage motorcycle jacket, for fear that he would rip them to shreds with his imagined nail-blades. “I can’t touch babies,” he says. “They’re too delicate. My dog, I play with him but I cannot touch his face, his eyes, for fear I’ll cut him.” At times when Domingo and his wife made love, he drew back from touching her, especially her chest. As he said at the time, “I think I’m going to cut her. I keep thinking I’ve got blades on me, and my hand begins to shake, my muscles get real
tight, and I have to pull back. My eyes see there are no blades, but my mind won’t believe. And I have to ask her, ‘Are you okay? Did I hurt you?’”

Through therapy, he has learned a basic truth: “You have to be stronger than OCD, physically and mentally. If you’re not, it will eat you alive. It will put you in bed, and you will rot like a vegetable.” Most days, when seized by a compulsion to wash or check, he is able to say to himself, “This is not real. You have to stop. You have things to do.”

Domingo makes himself choose: “Am I going to listen to this OCD or go and do my laundry? I tell myself, ‘It’s going to hurt really bad, but I have to go on.’ I close my eyes, take a deep breath, and just go through it—just push as hard as I can.”

Because he is capable of seeing quite clearly the difference between normal behavior and OCD behavior, he is able to bring himself around by zeroing in on reality. He reminds himself that a beautiful woman has chosen to be his wife and that she sees something special in him. “Look at all you’ve done,” he tells himself. “This is the reality you have to grab onto. You have to stop this thought right now. You must. If you don’t stop this, it will take over—and then what?” Domingo knows that if he gives in to the compulsion or the thought, it will keep going around and around in his brain, sapping his energy and wasting his time. He calls this “brain loop.”

He also knows that even if his OCD is never cured, he now has the upper hand. “Before, I couldn’t count the compulsions. One would go, and another would take its place. Now I know how many I’m fighting. Before, they were coming from right and left. I was overwhelmed. Now I know where it’s going to get me. I’m ready. I don’t listen to my OCD because I know it’s fake. I let it go quickly.”

TELL IT TO YOUR TAPE RECORDER

Another regular in the OCD group is Christopher, a devout young Roman Catholic who for more than five years has been battling OCD-induced blasphemous thoughts. Christopher’s disease reached a crisis point during a pilgrimage to a European shrine well known
as a site where numerous apparitions of the Virgin Mary have been reported. Though he had gone seeking spiritual enrichment, to his horror, he found himself in the little church one day thinking, “The Virgin Mary is a bitch.” Profoundly sad and ashamed, he broke down and cried. Back home, these blasphemous thoughts piled one on another. He began having thoughts that the holy water is “shit water,” the Bible a “shit book,” the churches “shit houses.” In Mass, he would imagine the holy statues naked. In his OCD-invaded brain, priests had become “scoundrels.” The mere sight of a church made him cringe.

In desperation, Christopher checked himself into a psychiatric hospital, where he was diagnosed as paranoid psychotic and questioned about being “demonically possessed.” It would be two years before he was correctly diagnosed as having OCD.

Christopher is one of the patients who has found the use of taperecorded loops a useful tool in performing the Relabel step. This simple and effective technique was developed by Dr. Paul Salkovskis and Dr. Isaac Marks in England. Anyone can practice it at home. All you need are answering machine tape loops—thirty seconds, sixty seconds, and three minutes—a cassette player, and headphones. The idea is to record the obsession, repeating the thought over and over, and then to listen to it repeatedly, perhaps forty-five minutes at a time. The tape will keep relooping over itself, so there is no need to rewind.

Christopher suggests writing complex obsessions down in shortstory form before taping, creating a scenario in which the dreaded consequences actually come true. For example, “If you have scrupulosity and religious obsessions, have God strike you dead and throw you into the fire at the end. If you obsess about committing a crime, have the police arrest you and make you spend the rest of your life in jail. If you fear dirt and germs, make yourself look like you fell in a pool of mud or came down with a deadly germ-spread disease and died. The important thing is to make the obsession look as stupid and ridiculous as possible.” On a scale of one to ten, playing the tapes should cause anxiety in the five or six range at the beginning of a forty-five-minute session.

Another tip from Christopher: “I prefer using one of those big
boom boxes. I found that, with the small players, I would often be tempted to get up and do things because it’s very easy to carry those things around. That’s not very effective for behavior therapy. A big boom box kind of makes you sit there.” When privacy is important, of course, you can use headphones.

The idea of the tape loops is to create anxiety that will peak and then ebb. The person listens to the tape perhaps twice a day for several days, perhaps as long as a week. “Eventually,” Christopher promises, “you’ll get to the point where you can’t stand even listening to it, not because it’s too anxiety-provoking but because it’s too boring. That’s why it works.” It’s also helpful, he believes, to keep a chart of your anxiety levels at ten-or fifteen-minute intervals. After some days have passed and the anxiety level is at zero, it’s time to rerecord the tape, this time in more anxiety-provoking language, and then do another tape, working toward recording the most anxiety-provoking aspects of the obsession.

Christopher cautions, “Don’t expect that after these sessions you will no longer have the obsessive thought. It’s just that you will more easily dismiss it from your mind and, eventually, it should decrease.”

Before behavior therapy, Christopher had literally dozens of obsessions, including violent thoughts about flying knives. “I used to have these horrible, wild fits where I would take a pillow and hit my face into it really hard and scream at the top of my lungs, punching the pillow or punching the couch. The OCD was so bad. It was terrible.” At first, working out his anxieties with the tape loop was no picnic. “There were times when the anxiety shot through my body so bad that I felt like a woman giving birth…that much pain. I would be sweating, and my arms and hands would be tingling. That doesn’t happen anymore.”

“DEAR DIARY”

As part of cognitive-biobehavioral self-treatment, I urge patients to keep a journal of their progress. Christopher, a faithful journal keeper, says, “I’ve found that whenever I recover from an OCD symptom, the natural tendency is for that symptom to become relegated to the back of my mind or forgotten. That’s the goal, of
course, but as you forget each symptom, you tend to forget your progress.” Without this written record, he believes, the road to recovery is “like taking a journey across a desert and only walking backwards, while wiping away your footprints with your hand. It looks like you’re always at the starting point.” The critical point is to chart your progress, to keep a record of your behavior therapy efforts. It can be short and simple. It doesn’t have to be fancy or complicated.

Christopher also uses the Impartial Spectator in Relabeling. He prefers to call it “my rational mind,” as in, “My rational mind says this isn’t true. This is reality. This isn’t. I’m going to follow the advice of my rational mind.” This is a perfectly legitimate and accurate alternative term. It’s the action of making mental notes that’s important, not what you call the process of mental observation.

Think of the Impartial Spectator as a vehicle for distancing your will from your OCD. In other words, create a safety zone between your internal spirit and the unwanted compulsive urge. Rather than respond to the urge in a mechanical, unthinking fashion, you present yourself with alternatives. As you’ll learn later, it’s good to have some alternative behaviors up your sleeve, so you’ll be ready when the intense pain occurs. As Domingo said, “This thing, OCD, is damned clever. You have to keep your wits about you to beat it.”

Frequently, patients find that one symptom disappears, only to be supplanted by another. However, a new symptom is always easier to control than one that has been long entrenched. Without treatment, OCD will just beat you into submission. Anticipate—be ready to resist this thing early on—and it will be far less painful.

HUGHES: BEYOND BIZARRE

This disease, OCD, manifests itself in ways that give new meaning to the word
bizarre
. Consider, once again, Howard Hughes. He went so far as to come up with a theory he called the “backflow of germs.” When his closest friend died of the complications of hepatitis, Hughes could not bring himself to send flowers to the funeral, fearing in his OCD-controlled mind that if he did, the hepatitis germs
would somehow find their way back to him. Hughes was also a compulsive toilet sitter, once sitting for forty-two hours, unable to convince himself that he had finished the business at hand. This is not a rare OCD symptom, and I’ve treated a number of people for it. When they’re ready to get better, they’ll say, “I’d rather soil my trousers than sit here another minute.” Of course, no one has ever soiled his or her clothing.

Senseless repetition was another common symptom that Hughes was observed to have. Hughes, a cross-country pilot, once called an assistant to get the Kansas City weather tables before he took off. He didn’t ask for those tables just once. Although he got the information he needed for his flight the first time, he asked thirty-three times, repeating the same question. He then denied having repeated himself.

Interviewing me for his book on Hughes, Peter Brown asked, “Why couldn’t he stop it, someone as brilliant as he was?” Brilliance has nothing to do with it. Hughes had the feeling that something really bad was going to happen if he didn’t repeat that question 33 times. In this case, the catastrophic thought may have been that the plane would crash. Maybe he’d planned to ask the question only 3 times—to quell his OCD-induced anxiety—but didn’t put the accent on the right syllable, or something equally ludicrous, the third time, and thus felt compelled to ask it 33 times. Had he not gotten it right then, he might have had to ask it 333 times. These kinds of symptoms are common with severe OCD. The fact that he denied repeating himself indicates that he felt humiliated by having done the compulsion.

While testing an amphibian plane, Hughes insisted on landing in choppy water 5,116 times, although the aircraft had long since proved its seaworthiness. He just kept on and on, and no one could stop him. When this incident was reported in earlier biographies of Hughes, it was explained by Hughes’s need to be in control. Other things in his life were slipping out of control at that time, among them his fortune. That may be part of the explanation for his behavior, but I believe that the answer is less related to deep emotional factors and that Hughes wouldn’t have behaved this way had he not had OCD.

THE CASE OF THE FLYING PAPER CLIPS

Josh had a whole range of bizarre OCD symptoms. One was a fear that he had brushed against someone’s desk at the office, thus causing a paper clip to flip into that hapless person’s coffee cup. In Josh’s worst-case scenario, the person would then drink the coffee and choke on the paper clip. Now, Josh knew there was a one-in-a-million chance that a paper clip would flip into someone’s coffee cup, yet he couldn’t get the idea out of his mind.