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Copyright 2003, 2014 by Jonathan Grayson, PhD.
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eBook ISBN: 978-0-698-15385-1
The Library of Congress has catalogued the Jeremy P. Tarcher/Penguin hardcover edition as follows:
Grayson, Jonathan.
Freedom from obsessive-compulsive disorder : a personalized recovery program for living with uncertainty / Jonathan B. Grayson.
p. cm.
Includes index.
ISBN 1-58542-246-0 (alk. paper)
1. Obsessive-compulsive disorderTreatmentPopular works. I. Title.
RC533.G725 2003 2003050723
616.85'22706dc21
PUBLISHING HISTORY
Jeremy P. Tarcher / Penguin hardcover edition / September 2003
Berkley trade paperback edition / September 2004
Updated Berkley trade paperback edition / May 2014
Cover design by Elaine Groh.
Interior text design by Tanya Maiboroda.
Every effort has been made to ensure that the information contained in this book is complete and accurate. However, neither the publisher nor the author is engaged in rendering professional advice or services to the individual reader. The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consulting with your physician. All matters regarding your health require medical supervision. Neither the author nor the publisher shall be liable or responsible for any loss or damage allegedly arising from any information or suggestion in this book.
While the author has made every effort to provide accurate telephone numbers and Internet addresses at the time of publication, neither the author nor the publisher is responsible for errors, or for changes that occur after publication. Further, the publisher does not have any control over and does not assume any responsibility for author or third-party websites or their content.
Version_1
To Cathy, Josh, and Jane
Precious are our memories, joyous are our future hopes, and as for the present, our here and now, I couldnt ask for more.
Contents
Acknowledgments
I am where I am today because of the contributions and efforts of many people. As one might expect, I have to start with my mother and father, Hal and Helen Grayson, who gave me the confidence to try anything, the courage to fail, and the humor to appreciate it all. Thanks to Tom Borkovec, my mentor in graduate school, whose wisdom, friendship, and curiosity about everything sharpened my thinking and whose extreme patience taught me to write, thus making this endeavor possible. To Edna Foa, whose work with OCD is still the cornerstone and core of our treatment. To Gayle Frankel, the members of GOAL, and everyone I have worked with, this is for you (Im sorry there isnt enough space to name all of you): There is no way to measure what I have learned about life from witnessing the courage you have displayed in your quest for freedom. To my peers at my former center, the Anxiety and Agoraphobia Treatment Center, and my current center, the Anxiety and OCD Treatment Center of Philadelphia: Joanne Dobrowski, B. J. Foster, Lori Kasmen, Harold Kirby, Leslie Lenox, Kathy Rupertus, David Raush, Georgia Sloane, Linda Welsh, Lee Fitzgibbons, Karen Landsman, and Tejal Jakatdar; you are my second family, providing support and stimulation, never letting me get away with anything (well, not too much), and, in the words of Leslie, making work a fun place. I also have to thank my longtime colleagues and friends, Charles Mansueto and Alec Pollard. Its as if we were there at the beginning and I cant thank you enough for all of the inspiration, discussion, and unrestrained fun.
I also want to thank my agent, Jessica Lichtenstein. She found me and made this book possible. Her optimism and energy were a constant source of support. I can think of few tasks more painful than editing an authors first book. With the patience of a saint, Wendy Hubbert at Tarcher guided me through this ordeal, and my gratitude to her knows no bounds.
And, most of all, my family. My son, Josh, whose life has filled me with more love than I would have believed possible. Thank you for so cheerfully allowing me to make the vignettes of your trials and tribulations part of my clinical repertoire. To his wife, Jane, for completing his life and ours. I want to thank you in advance for your life stories that will undoubtedly become part of my clinical repertoire. Finally, to my wife, friend, and lifelong partner, Cathyeverything is from you and for you. What a long, strange trip it has been! For more than forty years, I have shared everything with you, and still you are the endless source of all that I could ever want: a dream come true. Without your patience, sacrifice, support, and help during this endeavor, this book wouldnt be.
Introduction
I was standing in an open field, looking back into the forest and brush, watching the others struggle their way out. It was raining. I had purposely taken everyone off trail through trees and undergrowth so densely packed that forward movement was a slow process of stepping over and through bushes and being on guard for branches snapping back from whoever was in front of you. Melanie, the fourth person to emerge into the freedom of the clearing, shouted, Im having a great time! The photographer documenting our trip for People magazine snapped a picture. Seeing Melanies joy, it was hard to connect this woman with the one Id met seven months earlier at my former center, The Anxiety and Agoraphobia Treatment Center in Philadelphia.
When I met Melanie at our first session, she was an extreme suicide risk all medications in her home, even aspirin, had to be locked in a safe. Her parents wouldnt permit her to carry more than two dollars at a time, fearing that access to more money would enable her to commit suicide with over-the-counter medications. She was an attractive and articulate twenty-nine-year-old with a fifteen-year history of both obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD). Her OCD focused on issues of perfection. When taking notes during class, if there were any cross-outs, stray marks, folds, or creases in her notebook, she would feel compelled to discard the page. Similarly, she wouldnt tolerate any such marks in her textbooks and would cope with such imperfections by not using the text. Though she found school a nightmare of anxiety, Melanie did well in the courses she managed to complete. But many of her attempts to go to school resulted in anxiety and depression severe enough to require psychiatric hospitalization.