Brain Lock: Free Yourself From Obsessive-Compulsive Behavior (22 page)

It may sound funny to say that you need to remind yourself of what you’re thinking about, but all people need to develop that ability, and a lot more so than they may realize. As mindful awareness increases and making mental notes (in which you consciously notice
your thought stream) becomes more natural, you will quickly realize just how much of the time you spend thinking about things that you didn’t even know you were thinking about. These principles apply to everyone. People with OCD who do the Four Steps develop abilities that are very helpful in life—abilities that people without OCD may never develop. That may be one of the genuine silver linings of having OCD and using the Four Steps to overcome it.

OCD can function like an exercise machine in your head. Just as working out on an exercise machine increases your physical power, working on OCD increases your use of the Impartial Spectator, which will increase your mental powers and insight into both your own and other people’s behaviors. What’s more, your control over your internal mental life, even in things that have nothing to do with OCD, will be greatly enhanced. You will genuinely increase your personal freedom through the exercise of the Four Steps because the essence of having a mind that is free is the capacity to tame and direct the restless wanderings into which the unattended mind inevitably falls. With the making of mental notes, you will come to realize quite rapidly that much of the content of your mental life, of your ongoing thought process, concerns subjects that are not conducive to living a wholesome and happy life.

One of the most amazing things that you learn when exercising mindful awareness and using the Impartial Spectator is how much the mere observation of the content of your thoughts tends to direct them in a much healthier manner. In other words, knowing what you’re thinking at any given moment tends to direct the mind away from destructive ruminations, onto more constructive and wholesome subjects.

Mindfulness itself is an extremely helpful and wholesome mental state. Any moment in which the mind is exercising mindful awareness or using the Impartial Spectator is a moment in which an unwholesome thought cannot arise. Thus, the longer the period that mindful awareness is applied, the stronger the mind becomes and the less you actually experience the unwholesome and destructive types of thoughts that tend to lead to pain and suffering. Unfortunately, however, with unimaginably rapid speed, the mind can make the transition from a wholesome and mindful condition to an
unwholesome and negative one. The bright side is that by reapplying mindful awareness, you can reestablish a wholesome mental state just as rapidly. For instance, if a string of unwholesome ruminations on craving or anger, greed or ill will, is broken by making a mental note that “I am now thinking a thought related to greed” or “I am now thinking a thought related to ill will or anger,” the very breaking off of that stream of unwholesome thought processes by wholesome mindful awareness will itself lead to further wholesome thoughts concerning something functional and healthful to both you and others.

This makes the Refocus step much easier to apply. As time goes by and this process becomes more and more a natural pattern of living, your mind will become sharper and more at ease and your life will be smoother and happier.

To sum up: Having OCD is a curse, but your natural ability to use the Impartial Spectator and practice mindful awareness is a blessing. If having OCD leads to your developing wholesome mental abilities that you otherwise might not have acquired, there truly is a silver lining inside of the cloud. That’s what practicing the Four Steps is about.

KEY POINTS TO REMEMBER

• Keep in mind the power of the Relabel step: It’s the difference between knowing what’s real and living in fear of shadows.

• Always ask yourself, “Why am I doing this?” and keep the perspective of your Impartial Spectator in mind when answering.

• Make mental notes to remind yourself what you’re thinking about. Just the act of observing tends to direct thoughts in a wholesome direction.

• Any moment the mind is using the Impartial Spectator, an unwholesome thought cannot arise.

6

OCD as a Family Disorder

O
bsessive-compulsive disorder (OCD) is, in the truest sense, a family affair.

Typically, people with untreated OCD find themselves increasingly isolated from others, preoccupied with their terrible thoughts and urges, and choosing out of fear or shame, or both, to share their awful secret with no one.

Within families, this can be devastating. Again and again, our patients at UCLA tell us, “I’m driving my wife crazy, pushing my friends away from me. My family can’t stand it anymore. I have to stop doing this.”

JUST SAY NO

Commonly, people with OCD fall into a pattern of using OCD as a “weapon” in interpersonal conflicts. In one frequently observed personality disturbance, dependent personality disorder, the person with OCD becomes dependent to a pathological degree on the people he or she lives with to get things done. Family members become part of the OCD—enablers—actually doing the compulsive behaviors for the person to keep peace in the household. The person will demand, “Check that lock for me” or “Scrub the walls for me.” By giving in, of
course, the family only ensures that the person will continue to get worse; nevertheless, out of sheer desperation, they usually give in.

Spouses have told us that if they refuse to be drawn into the bizarre behaviors, they are met with tantrums and tears. Eventually, all their energy may be poured into trying to cope with the person’s illness. They may cajole or plead with the person to stop—or they may lie and say that they did such-and-such a thing or avoided doing so-and-so. Lying, of course, is not helpful to the person with OCD in the long term. The wife of one man with severe OCD acknowledged that she does not tell her husband the truth about where she has been if the truth will cause him to react violently because of his OCD fears. Once, she went someplace that was “off-limits” and thought for a moment that she had seen him. “I actually began having palpitations. You’d have thought that I’d robbed a bank and the police were right behind me.” If he asks her outright if she went where she wasn’t supposed to go, she will tell little white lies. She reasons, “If I say no, this man gets to have a nice dinner and a lovely evening and so do I, instead of an episode of swearing and slamming doors.” Lying makes her life bearable. She knows she shouldn’t be buying into his illness, but after years of coping with OCD, she’s weary. “So I’m an enabler. One little word and my evening’s nice.” Doubtless, there are thousands of women who can relate to her predicament. What she does is perfectly understandable, perfectly human. But, in truth, she is sabotaging his progress. When she learns the Four Steps herself and works to help him apply them, they’ll both be much better off. She’ll stop being an enabler of his OCD and start being a behavior therapist. The one-line message for family members is: “Don’t enable the OCD—enable the behavior therapy.”

A child with OCD can totally disrupt a family, waking them many times during the night with demands and dictating their lives down to where they must sit in a given room and at precisely what time they must do X, Y, and Z. Too often, parents allow themselves to be sucked into this behavior because they have heaped guilt on themselves, convinced that they are responsible for the child having this awful illness. As you shall see, both environment and genetics play a role in most cases, but the biological factors are the
primary
reason the person has OCD. However, emotional and environmental fac
tors are often the critical ones in determining whether the person does behavior therapy and gets better.

OCD AS A WEAPON

Although the family cannot force the person with OCD to get well, they
can
take charge of their own lives, refusing to participate in enabling symptoms, to be prisoners in their own homes, or to be what in popular psychiatric jargon is called codependent. The confrontation may not always be pleasant, but the end result is that the person is apt to improve. The bottom line is always this: Is the family member helping or hindering the person’s efforts to do the Four Steps?

Consider the case of a family in which one member has a contamination obsession. Parts of the house may become off-limits to the entire family. The person keeps everyone out because of an overwhelming fear that they will make the area dirty and he or she will then have to start on an out-of-control cleaning binge. (Ironically, when cleaning compulsions get really bad, whole rooms may become profoundly filthy because the person with OCD is afraid to start cleaning, and no one else can enter the room.) In some cases—and they aren’t that rare—people have actually ended up living in tents in their backyards. Even when the obsession doesn’t get to that stage, the usable inside space tends to keep shrinking and shrinking. In addition, objects become off-bounds; perhaps none of the dishes or eating utensils can be used, or certain items of clothing cannot be worn.

The partner or spouse must take a stand. After the 1994 earthquake in Los Angeles, Olivia began obsessing that water from the toilet was somehow flowing into her washing machine. She would check and check and then ask her husband to stick his hand inside, just to make sure. When I talked to them together, I advised him to start telling her that he would look, but he wouldn’t put his hand inside. He would also remind her to Relabel and Reattribute. He was to reassure her, “There’s no water. It’s just an obsessive thought, a false message from your brain. We’ll check it quickly to get the compulsion out of the way and just move on.” After a few days, he was to go one step further and ask, “Are you sure you really want me
to do this? Let’s Refocus on another behavior.” The strategy paid off. In time, her urge to check decreased markedly.

When those with OCD ask others to help them do their dreadful tasks, they may simply be so overwhelmed by intrusive thoughts and urges that they feel they need more hands to help them perform their bizarre rituals. On the other hand, they may well have a hidden agenda that they may not be aware of themselves: people with OCD frequently use it as a weapon in interpersonal conflicts. For example, if they want to annoy another person or get even for some real or imagined hurt, or if they perceive that they are powerless in the relationship and that their OCD can give them power, they will be less motivated to fight off their urges and the uncomfortable feelings the urges cause. Moreover, when they feel that their suffering is being demeaned or underestimated by other family members, they may be especially apt to try to get even by making other people’s lives miserable, either quite willfully or only half-consciously. A psychological tug-of-war ensues.

In behavior therapy, we draw a line in the sand right off, explaining very clearly to both the person and his or her family that this is not acceptable behavior. Involving family members in treatment is essential, both for support and to educate them about OCD.

WHO IS THIS STRANGER?

In time, through faithful practice of self-directed behavior therapy, people can and do change their brain and conquer their OCD symptoms. But as the person with OCD gets well, family dynamics are apt to change, often with devastating psychological consequences. Roles become reversed, and the once-powerless partner may make a power play. Others in the family may resent that the person has improved because now the family has to start facing its own realities and shortcomings, which may not be related to the OCD. The person is no longer an excuse for the family’s failings or a doormat. He or she is someone with newfound self-esteem, demanding to be dealt with as a fully functioning member of the family. Suddenly, there is a stranger in their midst.

Thus, when the person starts to improve, the family may unconsciously begin to undermine the treatment. For example, for years
one woman with OCD had made her husband jump into the shower as soon as he came home from work because she thought he was contaminated. When she began to get better in therapy, he preferred to keep doing so than to have a well wife who might start asserting herself in more worrisome ways.

Dr. Iver Hand, the distinguished University of Hamburg psychiatrist who has been studying OCD for 20 years, believes that intimacy issues are a primary fueling factor in maintaining the disease, that people get a “secondary gain” from the OCD—that is, they use it to keep others at an emotional distance. At UCLA we have demonstrated that people can be taught to let go of their OCD without addressing intimacy issues, but these secondary gains are the primary reason why some people do not respond to treatment. In other words, if a person with OCD has a well-entrenched pattern of fending off people, he or she will also find reasons to fend off doing the hard work of behavioral therapy. Although I am convinced that OCD is more a biological than an emotional disorder, there is almost certainly an interface between the two. In therapy, the person must be honest about these underlying issues if he or she is to get the maximum beneficial effects.

EMOTIONAL BURNOUT

At UCLA, our patients have taught us a great deal about the nonbiological manifestations of OCD—how it affects personal relationships, professional goals, and life paths.

Christopher, who had terrible blasphemous thoughts, is young and single and would like to have a girlfriend but is unsure of whether a “normal” woman could be attracted to him. And, he says, “I have this rule that I really can’t have a relationship with girls who themselves have OCD or some other kind of mental disorder. I can’t have that because I don’t really want OCD or, more generally, mental disorders to have any more of a part of my life than they already have had.”

Michael, who has the obsession about his pants being too tight, until recently felt extremely uncomfortable in most social situations, unable to “fit in”—and relationships with women were no exception. He believes that his OCD, which he has had since childhood, is at the root of these feelings of social inadequacy. In grade school, he
tended to be distracted by OCD compulsions, such as repetitive counting, and although he knew there was something strange going on, he never felt able to talk to his parents about it. As a consequence, they put his poor performance down to his being “lazy and kind of disturbed,” a bad person. (Kyle, who had violent OCD thoughts about himself and others, had an even worse childhood experience: His parents heaped guilt on him, telling him that his odd behaviors were just the “Satan in him.”)