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Useful for some types of OCD, but simplistic and judgmental
on September 11, 2006
This book teaches OCD sufferers four steps to use to control their disorder, starting with "relabeling" their fears and urges as just a symptom of a disorder, rather than "something real." By reading the case studies, I figured out that "relabeling" means telling yourself, "My urge to perform my compulsive ritual is not a supernatural omen that something terrible will happen if I don't perform the ritual; it's just a symptom of OCD." The author never actually explains this, however.
The technique described in this book may be quite useful for people who have the most common form of OCD - a fear that something terrible will happen if they don't perform some ritual. However, it's not really clear how to apply the techniques in this book to forms of OCD that don't involve a fear of some catastrophe. For example, the author never really says (or gives a good example of) how to apply relabeling to a tendency to horde objects, an urge to pull out one's hair, an irrational belief that one is ugly, etc, although he claims his techniques work for all of these problems. I suspect that these other forms of OCD need a completely different approach.
Worse, the author makes it sound as if beating OCD is relatively straightforward, and that if his technique doesn't work, it can only be because the patient didn't try hard enough. He seems unwilling to consider that his approach may not work for everyone, preferring to place the blame on his patients instead. For example, he describes one patient, Brian, who had an intense fear of contamination from battery acid. Brian would sneak to the scene of car accidents in the middle of the night to apply baking soda, which he felt would "neutralize" the contamination from a possible car battery leak. Most of the case histories in this book are success stories, but in Brian's case, treatment was a failure and his story is presented as a way of illustrating the toll that OCD can take on the patient's family. From reading the case history, it seems clear to me that Brian had not only OCD, but also a phobia of batteries. For example, he was terrified if he saw a battery. (Unlike, say, OCD sufferers who check and re-check their stoves but aren't terrified by seeing a stove.) Given that Brian had a phobia of batteries, it might have helped to add a treatment for the phobia (e.g., systematic desensitization) to the OCD treatment, but it appears that the author never tried this. Instead, he concludes that treatment failure was all Brian's fault, saying that Brian must not have been motivated to overcome his OCD, even though Brian said the OCD made him so miserable that he wanted to die.
Also, the author seems quite opposed to long-term drug treatment (he trivializes drug therapy as being like "water wings" for swimmers) but never gives a reason why. He also is critical of OCD sufferers who are willing to put up with some residual symptoms, even if those symptoms aren't interfering much with their lives. These seem to be moral judgments, with no acknowledgement that patients are entitled to choose what treatment works best for them.
In conclusion, this book will be helpful for some OCD sufferers, but it is marred by a tendency to overstate the patient population who can benefit from the author's techniques, and a tendency to blame patients who don't have complete success with the author's techniques.