Brain Lock: Free Yourself From Obsessive-Compulsive Behavior (8 page)

Josh then developed an obsession that he had grazed a parked car while driving and, in doing so, had knocked loose the hood ornament or a chrome strip. Then he imagined, “That guy’s driving along the freeway, and the part falls off and kills six people.” Josh went so far as to memorize the license plates of all the cars that regularly parked on the street where he lived so he could check each day to make certain they were there, intact, and everything was fine. But he was constantly plagued by worry about cars that he might have come in contact with during the day and would not be able to trace. Once, he drove two hours in a vain effort to track down a car on which he had inflicted imaginary damage.

Another time, Josh flew to St. Louis on business, flew home to Los Angeles, then turned right around and flew back to St. Louis, intent on finding the car on which he imagined he had loosened the hood ornament.

Josh knew that none of his actions made sense, but he also mentioned—and this shows a deep insight into OCD—that sometimes when dealing with a particularly vexing business problem, he found that his compulsions, unpleasant as they were, had the power to divert him. During a very stressful time, he would literally prefer to be doing the compulsion to thinking about what he was supposed to be doing at work. In the same way, Howard Hughes might have been using a compulsion as an outlet. First, there was just the thrill of that amphibious landing, but he soon developed a compulsion around it. Without behavior therapy, which teaches you how to resist those urges, the urges can escalate into an unstoppable cycle. The lesson is:
If you let your emotions cling to an OCD behavior, the behavior can easily get out of control
.

In a similar way, Josh tended to have relapses during treatment because, by his own admission, he would let his guard down when his OCD symptoms were, say, 80 percent gone. As a consequence, he’s been dealing with the same symptoms for a number of years, never quite dispatching this devil OCD, doing the Four-Step method just enough to give him a livable comfort level. Then, in times of stress, his OCD flares up badly. Josh had the insight to realize that, in effect, his brain was looking for something mischievous to do all the time he’d put it in neutral. Mentally, he was allowing the OCD to lie in wait and not attacking it aggressively enough.

What he should have been telling himself was that by doing the compulsion, he was only assuring himself that another compulsion would follow, that his ability to function effectively would decrease and his stress level would soar. He needed to be brave, to confront his OCD and work past it. It’s true, in this case, that a coward dies a thousand times before his death, but the valiant fight off OCD right now!

Howard Hughes’s germ-backflow theory is similar to an obsession described by Jenny, a professional woman in her early 30s with a longtime involvement in ecological and environmental issues. While working for a U.S. government agency in Moscow, she developed the obsession that radiation could spread and attach itself to things. This was only a few years after the Chernobyl nuclear disaster, so, as is true with many OCD thoughts, there was a small element of logic. However, Jenny’s reasoning was totally illogical. “When people would come in from Kiev or Chernobyl, I’d worry that radiation would just come off of them and contaminate my things. Any logic that I tried to infuse about the physics of radiation was not working. It was kind of a basic contamination fear.”

Always, what she really worried about was that she, in turn, was going to contaminate others. She began to keep separate in her closet those clothes that were still okay to wear when she was around friends. These were the clothes that she’d never worn when around someone who’d been near Chernobyl. Certain books and papers had to be disposed of. “I threw away perfectly good things because I thought they were contaminated. I didn’t want people getting them out of the trash, so I would rip them up to make them
unusable.” She became afraid to phone home, in fear that the “radiation” would somehow travel over the telephone lines.

ONE HOARDS, ANOTHER SCRUBS

With regard to the form of OCD and the content of OCD, it is certainly possible that a person’s life experience plays a role, especially in the content of that person’s irrational fears. Many of my patients believe this. Jenny, for example, wonders whether she might have been subliminally affected by a film on the bombing of Hiroshima that she saw on television when she was 12. She still recalls it vividly: “I couldn’t sleep. I kept thinking of burnt hands reaching up from behind my pillow and of faces with burnt skin sagging, faces staring at me.”

Jenny’s first OCD thoughts—of feeling compelled to tell people inappropriate things—date from early childhood. By her teenage years, OCD was a monster that had a real stranglehold on her. This moving diary entry was written when she was 18:

You are the awful…the awful. It has gone too far. There is no message, no inspiration, just pain. So that all else that is so fine is dulled. You are the duller, the awful…what fault mine? Possibly that I let you do this to me? No, I had no control. You took power of me, the fear holds me. Take your awful fingers from my mind…you awful…you be damned in heaven, hell the better. I hate it. I hate it. I hate it. I want to be free.

Using Four-Step self-directed therapy in combination with Prozac to make it a little easier, Jenny is now able to control her OCD. She is no longer afraid to mail letters because of some wild idea that they are contaminated. She forces herself to wear all the clothes in her closet. She says she would have no qualms about driving past a nuclear power plant or working near a nuclear reactor. One day recently, while cleaning out her office at a medical complex, Jenny came across a box in which were stored old cardboard covers for lab slides. “I had an idea that there were diseases in there. Well, I brought them out and put them on my desk and touched them and
said, ‘This is ridiculous. Pathogens die within seconds. It’s not me—it’s my OCD.’” She was able to put the absurd thought aside.

At UCLA, we have provided scientific evidence that OCD is related to a chemical imbalance in the brain, that critical parts of the brains of people with OCD use too much energy because the brain circuitry is out of whack. This is true across the spectrum of people with OCD. But OCD presents itself in a huge variety of ways, some outrageous, some ludicrous. In my behavior therapy group, patients sometimes can’t help but laugh at themselves, but the disease is so painful that I have long since learned never to make light of any symptoms.

Let me share a few more of our case histories from UCLA:

OLIVIA

Olivia, a middle-aged homemaker, developed an obsession soon after the 1994 Los Angeles earthquake that the water in her washing machine was contaminated. She even imagined that water from the toilet was somehow pouring into the washer.

LISA

Lisa, an X-ray technician, developed an irrational fear of lead. Because she worked around lead, it became a terrible problem. First, she imagined that her hands were contaminated, then her shoes, then anywhere that she had stepped. She began to designate “clean zones” in her home. She would warn people that she worked around lead, so they could get away from her. Washing became a time-consuming compulsion.

LYNN

Lynn, an attractive college student, became obsessed with picking at her face, trying to rid it of imaginary flaws. She had a condition called body dysmorphic disorder, which may be related to OCD. Ultimately, she had to lower all the lights in her apartment and tape sheets of paper over the mirrors. (A similar disorder, trichotillomania, or compulsive hair pulling, may also be related to OCD.)

KAREN

Far more typical is the case of Karen, a homemaker and former dental assistant in her early 50s. Karen is a hoarder. Her problem began as a harmless hobby early in her marriage, when she and her husband, Rob, would haunt yard sales for inexpensive treasures for their new home. Before long, Karen was bringing home useless curbside castoffs. In time, every room in their house was crammed so full of junk that it was impossible to open the doors. Even the bathtub became a dumping ground for this rubbish. So much stuff was heaped on the stove that only a single burner was usable. Only a narrow path was navigable through the living room, between trash bags and boxes stuffed to overflowing. With their sixteen cats and four dogs sometimes relieving themselves behind those piles of trash, the stench became gagging.

Karen recalls, “We were too embarrassed to invite anyone in.” There was no heat in the house because they were afraid that they would start a fire if they lit the pilot on the floor furnace. Throughout the house, there were only two sittable chairs. Appliances would break down, but Karen and Rob couldn’t get them fixed because they were terrified that a repairman might report them to the health department. They shuttered the bottoms of their windows and let the shrubs grow so no one could peek inside. Rob had lived with this mess for so long that he no longer viewed the situation as wildly bizarre. “Our home was no longer a refuge,” Karen says. “It had become a prison. We were foundering, like a sailing ship that is depending on winds that don’t come.”

For them, help came inadvertently from one of Karen’s former colleagues who dropped by unexpectedly. Karen was so humiliated that she gave up yard sales cold turkey, only to begin haunting book sales. Now Rob had to build library stacks to house all the books she brought home. Still, Karen did not seek help, fearing that she’d be committed to a psychiatric hospital. Finally, in desperation, she saw a psychiatrist who suggested that she just set up a dumpster in the driveway and purge the house. Karen wasn’t about to do that. “I could just see myself running out into
the yard, screaming and throwing myself on the dumpster and being forcibly removed to a psychiatric hospital—all in full view of my neighbors.”

Finally, after ten years of hoarding, she joined Obsessive-Compulsives Anonymous, a twelve-step program based on Alcoholics Anonymous. There she met someone who persuaded her to begin the long, hard process of cleaning out that would take years.

“My big mistake,” Karen says, “was that I thought I had to fix my problem myself. I had false pride. I did not want anyone to see my shame.”

At UCLA, we taught Karen the Four Steps, which she keeps pasted on her bathroom mirror and consciously invokes whenever she spots a tempting yard sale or an attractive item poking from a trash can. When Karen Relabels an obsession and says to herself, “Let it go!” she means letting go of both the obsessive thought and the fleeting wish to hang onto another piece of junk. “If I make the right choice,” she says, “I get to feel good about myself. I get to be that much closer to a rubbish-free, hassle-free environment. I get to be healthy. I get to have friends. I get to have a life!” One technique she uses is to get angry at all that stuff and how it’s wrecked her life. “I don’t just toss things into garbage cans. I throw them in with a vengeance, as if to kill them, as if our lives depended on it, and—in a deep sense—they do.”

BLAME IT ON YOUR GENES?

In telling her story, Karen mentions that she grew up in a rigidly perfectionist household with an eccentric father who would rant constantly against waste. She wonders if this experience mandated the content of her OCD, which is possible, especially since as yet there is no biological explanation as to why one person washes, while another hoards.

Other patients also reflect on their childhoods and their genetic legacies in attempting to find answers to why they developed OCD. Certainly, genetics does seem to play a role. Again and again,
patients have told me of mothers or sisters or grandparents who certainly had OCD tendencies long before the disease was given a label. Formal studies show the same thing: OCD tends to run in families. Frequently, parents of people with OCD were rigid and inflexible and became very uncomfortable if things weren’t done in a certain way. For example, at five on the dot each day, Howard Hughes’s grandparents went out on the porch of their summer house. As a child, Howard had to be there precisely at five, or there was hell to pay. One can think of this kind of rigidity as low-grade OCD. These traits can be highly advantageous if you are, say, a surgeon or an accountant, but they can become pathological if they are amplified. Thus, it’s not surprising to see that a precursor of an OCD biochemical imbalance is this much less disruptive habit-based brain function.

Childhood-onset illnesses have also been linked to OCD. Dr. Susan Swedo’s group at the National Institutes of Health has established a link between OCD and Sydenham’s chorea, a variant of rheumatic fever that involves an autoimmune attack on the brain. Her work implicated Sydenham’s chorea in both the onset and exacerbation of OCD. The fact that there is a strong relationship between Tourette’s syndrome, a motor tic disease, and OCD is also intriguing. The link between childhood psychological experiences, especially traumatic ones, and classic OCD is less clear, but some of my patients are convinced there is one.

Michael, a stenographer, feels strongly that his OCD stems from growing up in a household with a father who would dwell for days on minutiae and a mother he describes as an “anal-retentive” compulsive cleaner. He recalled: “My mother tended to be very overpossessive. But, though she smothered me, she didn’t nourish me in other ways. Which is the same thing my OCD does. You know, you have all this potential that is smothered. I remember other kids taking piano lessons, whatever, but she never allowed me to do those things. She just did the smothering. With OCD, you might have the potential, but it smothers you and does not allow you to get it out.”

Michael describes himself as having a “Dr. Jekyll and Mr. Hyde brain,” with a good side and a bad side—the OCD side. He has had counting and touching compulsions, compulsions about “good”
numbers and “bad” numbers, and compulsions to repeat sentences over and over again in his head. But his most bizarre compulsion—one with which he still struggles—began in fifth grade. “I would be sitting in class and suddenly I would feel my pants were too tight.” He was unhappy in school, partly because his OCD made it difficult for him to concentrate, and he now wonders if this feeling of creeping pants was some sort of subconscious distraction technique.