COVID-19 Creates Heightened Stress for People With OCD

OCD, rituals
Reading Time: 30 minutes

Obsessive-Compulsive Disorder (OCD) affects millions of Americans, and one common symptom of this anxiety disorder is excessive handwashing due to an extreme fear of germs. As we are all instructed to increase our personal hygiene to reduce transmission of the novel coronavirus, many people with OCD are facing added stress.

In this Radio WhoWhatWhy podcast, author and radio newsman Jeff Bell explains the challenges for “OCs” at a time when average people are dealing with new fears of contamination. Bell has personally dealt with OCD for decades and offers insights that will deepen your understanding of a chronic condition that often leads to shame and irrational behaviors.

Bell’s book Rewind, Replay, Repeat: A Memoir of Obsessive-Compulsive Disorder is an exceptionally candid account of his personal odyssey and how he addressed OCD through cognitive therapy and medication. In this interview, he shares his darkest episodes, the science of the disorder, and how he mastered the coping skills that have enabled his personal and professional success.

Jeff Bell is a veteran radio news anchor at KCBS in San Francisco and the author of Rewind, Replay, Repeat: A Memoir of Obsessive-Compulsive Disorder.

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Full Text Transcript:

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Peter B. Collins: Welcome to another Radio WhoWhatWhy Podcast. In San Francisco, I’m Peter B. Collins.

As we’re all hunkered down, concerned about the spread of the novel coronavirus in the United States and across the globe, one subset of the population that I’m intrigued by and want to check in on is people with obsessive-compulsive disorder, OCD. And joining me today is Jeff Bell. He is a news anchor at KCBS radio here in San Francisco. And a few years back, he published a book, a memoir of his own experiences with OCD. The book is called Rewind, Replay, Repeat. And in a few minutes, we will delve into the book and into Jeff’s personal experiences.

Peter B. Collins: Jeff, thanks for being with us today.
Jeff Bell: Peter, thanks for having me. It’s an honor to be on your podcast.
Peter B. Collins: Well, thank you. Recently, I opened a podcast by saying with respect to people who have this anxiety disorder, that we’re all OCD now. I’m washing my hands every time I move from one room to the other or one location to another. I come to the studio here and work solo, but I walk in the door, I wash my hands, and I wipe down the studio compulsively. And these are behaviors that many of us hopefully, have adopted under the advice of the experts. But for people who have dealt with OCD, I don’t call it something that is curable or that you say goes away, but many people with the help of a specialist do learn mechanisms to live with it and deal with it.
Peter B. Collins: And this level of contamination or potential contamination from an unseen virus has got to be a real challenge for what you call OCs in your book. So take a couple of minutes here and tell us what it’s like for you and for others who you’ve been in touch with in this very special situation.
Jeff Bell: Yeah, Peter, I would say that the word I keep hearing over and over again from the OCD community is confusing. These are confusing times for those of us with the disorder. And to put all of this in context, let me just say a few words about OCD. Obsessive-compulsive disorder is a brain disorder. We know from PET scans and other forms of brain imaging that the OCD brain, if you will, is both functionally and structurally different from the non-OCD brain. So there is a physical component to this. That said, the OCD cycle, if you will, I think it’s very relatable for just about everybody. And what that is, is we have obsessions and these are intrusive, highly disturbing thoughts that literally get stuck in the brain of somebody with OCD.
Jeff Bell: And then we have compulsions that are these ritualistic efforts of ours that we take in an effort to try to dislodge that disturbing thought. So for those of us with contamination fears, the obsession might be, “What if I get sick?” Or in my case, “What if I get others sick?” I have what’s often called reverse contamination obsession. And then the compulsions, logically enough, would be to scrub my hands or to avoid contact with other people. Many of those behaviors that you’re talking about right now that the entire country is taking on, and rightfully so.
Jeff Bell: So what’s confusing is, those of us who battle the disorder are trained through therapy to stand up to our compulsions. So in normal times, if we are battling contamination obsessions, we would stand up to the compulsive urge to scrub our hands endlessly. Now, all of a sudden we’re being told, like all Americans and folks around the world, that we should be scrubbing our hands, as we should be, so the challenge becomes to follow the CDC guidelines as you are and not go beyond them right now. And so that in essence is the most confusing aspect of this. There’s also a positive side there too, if you will, and that is, those of us who have been through OCD therapy have been given some tools that I think are very helpful for learning how to navigate uncertainty that perhaps the rest of the world hasn’t been exposed to.
Peter B. Collins: Well, share a couple of those, please.
Jeff Bell: Sure. So there is what I call the uncertainty paradox in the world of anxiety disorder treatment, and that is the only way to effectively navigate uncertainty is to embrace uncertainty. Sounds very profound, but it’s actually true. And the best analogy that I’ve ever run across, Peter, and this comes from a book called Freeing Your Child From OCD, Dr Tamar Chansky. And she lays out this wonderful metaphor that if we think of anxiety as a pool of cold water, when we’re kids, we get into that cold pool and we are cold and our brains are yelling at us, “Cold, cold, cold. Get out, get out, get out.”
Jeff Bell: But we’re kids, so we stay in the pool, we splash around and low and behold, the water gets warmer. Well, of course the water didn’t get warmer. What happened? We acclimated to it. We habituated to it, to use the terms that the clinicians often use. Bottom line, we got used to it. Those of us with OCD really disdain being in cold water, if you will, so we keep getting out of it. We keep getting out of it with our compulsions. And rather than sitting in there and actually habituating to the discomfort of that cold water, that anxiety, if you will, we keep getting out.
Jeff Bell: I see people all around me right now without OCD who are doing the same thing. And in essence, what I would coach them to do is to sit with that anxiety, to stay in the cold pool of water because ultimately you will acclimate to that anxiety. So a lot of people are running away from the fear. They’re trying not to think about the worst case scenarios of all this, when in fact, if they embrace the uncertainty, that would go a long way in helping their anxiety.
Peter B. Collins: Jeff, one of the things that just personally has become obvious to me is that I reflexively touch my face all the time. I’ve got a beard, I pull on it. I feel a little something in my eye and I try to just pull it out with my finger. Many of these behaviors, we have a higher consciousness of at this point, but you introduced me to the term checkers in your book, and OCD persons are always checking. And what occurred to me when I read that and thought about it is that many people compulsively check their phones 10 times an hour. “Did I get an email? Did I get a text message? Do I have an alert?”
Peter B. Collins: And it becomes overwhelming and crosses the line from normative behavior to compulsive behavior.
Jeff Bell: Yes, yes. And I’m really glad you brought that up about checking because that brings up another major issue vis a vis the coronavirus outbreak for people with OCD. And all of these compulsions, and I should mention that there are so many different flavors of OCD, if you will. Some people have contamination obsessions, some people have religious obsessions, some people have order obsessions that things need to be in a perfect order and so forth. And then there are a variety of compulsions that are essentially developed to address those various obsessions. The common thread though for all of them is at the core of the obsession is a, “what if” question, a very disturbing “what if” question.
Jeff Bell: And then there are these compulsive actions that we take to try to dislodge that disturbing thought. So checking is a way of essentially seeking reassurance. So if you are checking your phone over and over again, it might be because you’re waiting for some important information and it’s very uncomfortable sitting with the anxiety of not knowing when you’re going to get it. So what do you do? You check it over and over again. For people with OCD right now, there is a strong compulsion to check everything they can about this disorder. And while I will never tell people not to tune into the news, that’s my livelihood, of course, those with OCD really are being coached right now to take it in good measure, to take that news in in good measure.
Jeff Bell: And likewise, with checking CDC websites and checking newspaper websites and seeking that reassurance that they’re looking for. So checking is a big issue right now for people. And I see that again extending beyond the OCD community. I see friends who are just compulsively following every aspect of this pandemic, and I think it’s become a “compulsion” for them.
Peter B. Collins: Well, and Jeff, you’re the journalist, I have no idea what your personal politics are so you can separate yourself from this comment. But I would just extend your remark by saying, watching a Trump daily briefing is confounding for everyone and has to be a trigger for many people with various anxiety disorders.
Jeff Bell: Well, let me give you a very apolitical answer to that, a response to that, and that is uncertainty. Regardless of political persuasion, anybody with OCD struggles with uncertainty. It is at the core of anxiety. It goes back to that “what if” question that I threw out there, that we all are battling with. And so when you get conflicting information day after day from our government and from other official sources, it just adds to the anxiety for anybody because it increases that uncertainty. So yes, I, as somebody who deals with advocacy in the anxiety disorders world would love to see a more consistent message coming out of our government that would at least do something to bring down that uncertainty level around all of this.
Peter B. Collins: Jeff, one other aspect I want to address regarding people who live with OCD is a form of agony that is linked to shame. And keeping it inside is something that you overcame, and your book is a testament to that. We’ll talk about it in a moment, but you show so much courage to expose your personal life in ways that I would never do, I just have to tell you. And it’s not because I’m some kind of a public personality, it’s just my own inhibitions and my sense of privacy. But for people who struggle with it, the feelings of shame and the need to keep it secret have to be a heavy, heavy burden.
Jeff Bell: Yeah. And thank you for asking that question because it’s an important one. Let me give you somewhat of a long-winded answer just in terms of why this is a critical issue right now. When I started doing-
Peter B. Collins: Jeff, please take your time. We’re in podcast land, there are no hard breaks coming.
Jeff Bell: Oh, wait a minute. That takes away all the fun. I have to do it live joined in two minutes. Well, that is freeing, Peter. You told me that, you’re right about that. Here’s the deal, Peter, when I first started doing OCD advocacy, I would ask an audience, a general audience, if you will, to raise their hands if they were aware of the term. And I’d say about a third of the hands went up, and this is going back, oh gosh, to about 2007 when I first started doing some advocacy around this. And so there was an awareness opportunity to educate people about what OCD is.
Jeff Bell: If I do that today, almost every hand goes up in the room because people know the term OCD. The problem is the term has really become an adjective for a lot of people when in fact it is something so much more than that. I hear people say, “Ah, my boyfriend is so OCD about cleaning his car.” Well, that might be an attempt to say he’s fastidious or he’s anal retentive, but it does not necessarily mean he has a brain disorder. And what’s happened is, the misuse of that word has trivialized what this disorder can do. I know you’ve done enough research, Peter, that you know this is a debilitating disorder and that it has crushed lives, millions of lives of people who have not had the benefit of getting treatment.
Jeff Bell: The good news about OCD is there is a treatment process, exposure response prevention, cognitive behavioral therapy, the gold standards of behavioral therapy that help people reclaim their lives. It works beautifully, I’m a testament to that, but a lot of people are not privy to that opportunity and a lot of people are unable to get through it early on and don’t stay with it. So what happens is you see a lot of lives really crushed through this disorder. And so to trivialize it by using it as an adjective is really tough. And so that has added to the shame, it’s become a punchline for a lot of people. Look at all the memes and the jokes on Facebook and whatnot about OCD.
Jeff Bell: I’ll tell you what, I make one prediction, I think we’re going to see fewer of those. I think that if there is a silver lining for people in the OCD community who are having to deal with exacerbated OCD during this pandemic, I’m hearing people say others are finally getting a taste of what it’s like to live with crushing, overwhelming, exhausting anxiety 24/7. And so I think that there is going to be a new appreciation for just how difficult this disorder can be for people.
Peter B. Collins: Jeff, in the book you estimate, or you cite estimates that roughly three to 4% of the population has a serious form of obsessive-compulsive disorder. Has the de-stigmatization led to actually a higher number? We know in many other instances, whether it’s sexual harassment in the military or even testing for COVID-19, that the more openness there is about it, the more accessibility to the subject and to resources, the numbers tend to go up.
Jeff Bell: It’s a great question, and I’m really interested to see some updated numbers. I have not. And the numbers out there were all over the place. The current estimates are about 1- 2% of the American public, so two to three million Americans. But those numbers are pretty outdated. And I’ve often wondered the very same thing that you’re asking: now that people are more open about it, will we see higher numbers? I think so. I certainly have a sense of that anecdotally as the guy who was sort of the poster boy for the disorder for a lot of years. As a national spokesman for the International OCD Foundation, I would get mail from around the world and hear from everybody I know.
Jeff Bell: And it just seems that everybody in my world, my circles, would have a story of somebody in their family who deals with some degree of this OCD. I don’t believe, by the way, that everybody has a touch of OCD, if you will. I think if we’re really using the term correctly, we’re talking about a neurological disorder that really is defined by its physical characteristics as well as its emotional toll. And I think that there is a distinction between having obsessive tendencies, for example, and actually having this disorder
Peter B. Collins: And Jeff, what kind of resources are available as people are confined to home for the most part right now. Are there hotlines, are there websites that you would refer to people to who are looking for support at this time?
Jeff Bell: Yeah. And thanks for asking the question. And I will put out there as a disclaimer that I spent about, gosh, eight or nine years as a board member and national spokesman for the International OCD Foundation. It is the clear clearing house, if you will, internationally, for information about OCD. And the website for that is simply IOCDF.org., IOCDF.org. I could not be more proud of what this organization is doing during this pandemic to address it. There is an entire section of the website that’s titled something like COVID-19 and OCD. And if you go there, there are a variety of resources that I personally find really helpful, reminders about doing just what the CDC is suggesting and not staying away from those guidelines, but challenging oneself not to go beyond them.
Jeff Bell: Self-care, a reminder that this is a really tough time. Community opportunities. There are town halls that are being done via Facebook and so forth. So that would be the first place I would point people. It’s a wonderful resource.
Peter B. Collins: Great. Jeff Bell is my guest. He is the radio host, a news anchor here at KCBS in San Francisco. And his powerful book is Rewind, Replay, Repeat, a memoir of obsessive-compulsive disorder. And Jeff, I just read your book last night and I can’t tell you how many ways it connected with me. And let me begin by sharing with you that I’m a sailor.
Jeff Bell: Oh, I did not know that.
Peter B. Collins: With partners, we have a 34-foot sloop on San Francisco Bay. And I’m going to begin with a recent event that still haunts me, but not to the extent that you’re going to share with us in a moment about your dad’s sloop called The Boat. And that is, I took some friends out sailing last year and the tide was coming in pretty strongly, and I misjudged as I rounded that buoy that is just offshore from the South tower of the Golden Gate Bridge. The buoy fortunately is not a fixed one, it’s a floater. And so as I turned around it, I thought I had allowed enough room, but I sheepishly saw that the tide brushed me up against the buoy and the stern made contact with it as I came around.
Peter B. Collins: Now, I checked the hull very carefully at the time and then when we got back to the harbor, but there was no damage, and I moved on. But the psychological impact of that as I read your book came back. So share with our listeners the very incredible almost year that you spent after you had a little incident where your motor conked out and you brushed against another boat in the harbor.
Jeff Bell: That’s right. Yeah. Wow. So this was the first major episode, if you will, of my adult onset OCD. I had childhood OCD, but it waxed and waned and I had a whole period of years where I essentially was symptom free.
Peter B. Collins: Well, and let me interject that you picked up an engineering degree and an MBA.
Jeff Bell: I did. I did. And I’m very grateful for those “normal years”, although I’ve come to find, Peter that there really is no such thing as normal out there, but my non-OCD years, let’s call them that. But yeah, my late 20s, I was on a fast track. I was again, in my late 20s and working in major market radio, I had a beautiful young daughter, happily married, life was just wonderful. And then all of a sudden things started getting really weird because I started obsessing about things and taking some very bizarre actions in response to those obsessions.
Jeff Bell: I had no idea what OCD was, I was misdiagnosed a couple of times. And before the actual diagnosis came, I had taken my dad’s sailboat out, a 30-foot sloop in the Bay and as I was backing the boat up, the engine died, it was a windy day. We got blown over to an adjacent dock and there were people on a boat that we were about to brush up against who fended us off and we were on our way. Never thought for a second that there was an issue. And then a guy on board made some reference to the creaking that he heard on the boat that we were fending off, and this thought popped into my head, “What if I have done irrevocable damage to this other boat?”
Jeff Bell: And then as only OCD can do, we ratchet up the “what if” questions. So, “What if that damage led to a leak in the hull? And what if that leak led to the boat sinking?” And so forth. And it was this huge obsessive nightmare night after night after night. And by the way, when we got back to the harbor that day, we went over and checked the boat, we talked to somebody on the boat, everything was fine. There was no issue. But one of the hallmarks of OCD is that we essentially cannot trust our own sensory processing. It doesn’t matter that I couldn’t find any harm or signs of harm, it didn’t matter that people told me everything was okay. There was just that what if question, based on my friend’s comment that he heard some creaking, that maybe something had happened. “What if… that boat sinks?”
Jeff Bell: And so night after night, I obsessed about it and I would go over and compulsively start checking. We talked earlier, Peter, about checking as a compulsion. I would check the boat, I would try to do it surreptitiously, so I’d sit down below in my dad’s boat and I’d use the binoculars to zero in on a boat across the way. And this went on over and over again. I found excuses to walk by the boat and check it out without looking like I was some kind of a stalker. I ultimately wound up talking to somebody on that boat again and had this ridiculous conversation about, “I know that you were there that day and everything seemed to be fine, but maybe you should check your boat again.”
Jeff Bell: I just didn’t know what to do with this anxiety, and it dragged on for months and months and months and I had no idea what was going on. Now, I’ve come to thinking in retrospect, Peter, that there’s nothing special about that particular episode, it was just the timing of it that it really proved to be the portal to my adult onset OCD that really opened up a door to some horrible, horrible years.
Peter B. Collins: And Jeff, just to dig in a little further, I’m wondering if there were external factors because you describe how you were an overnight news writer at Channel 2 when it was the most impressive television news operation in the region if not in the country. You describe how you’d work all night and then you’d go through these compulsive check-ins on both of these boats. And it occurs to me that you were exhausted, you were also working seven days a week because you were doing radio news anchoring at a KSFO where we both worked at different times. And I can just imagine that you were so wrapped up in this that you weren’t sleeping and that there were other health or wellness factors that were a challenge.
Jeff Bell: I am really glad you asked that, Peter, because I often forget to weave that into the story when I’m telling it, and it’s such a critical point. I do not believe that stress or lack of exercise or anything else can cause OCD, but it sure as hell can exacerbate the issue, and it absolutely exacerbated the issue for me. So I’m always very cognizant these days of trying to get enough sleep, to eat right, to exercise, take a holistic approach to dealing with anxiety, and it’s such an important thing to put out there right now. Again, bringing this back to the non-OCD community, it’s important for everybody who’s dealing with anxiety right now, to take care of yourself because these things like lack of sleep and lack of nutrition, absolutely exacerbate the anxiety that we’re feeling.
Peter B. Collins: And Jeff, you had a perfectionist father, the boat was always in top condition and spit polished. And you describe at least occasionally that he could be a screamer and pretty demanding and intense. And I’ll share that in my childhood, the scariest guy was my uncle Dan, he was 6’6″, he was a sailor, and I remember I learned to sail on a little reservoir in Ohio and I’d be out there in this pram with a single sail, and I could hear my uncle Dan screaming at the top of his lungs at his crew in a silly little beer can race on a freaking reservoir. And my brothers would crew for him and I refused, I said, “I don’t need it.” And to this day, I’m not interested in racing because it just conjures up these memories of uncle Dan.
Peter B. Collins: So how much did your dad and his perfectionist behavior, again, I’m not calling it a cause, but did it trigger and did it build walls that made it difficult for you to share your anxiety with him?
Jeff Bell: Absolutely. It’s so interesting too, for one of the great debates throughout the evolution of OCD advocacy and OCD treatment, has been nature versus nurture, to what degree is this based on environmental factors? To what degree is it based on genetic factors? I think almost to an expert this point, to book to a person, those who have the expertise will tell you it is at least largely biologically-based. That said, it’s my own hypothesis that our environmental upbringing shaped the nature of our OCD. I don’t know that, but for me, perfectionism, the challenges around perfectionism and certainly challenges with harm, have stemmed, I believe, largely from my upbringing with a very perfectionistic father.
Jeff Bell: So yes, the boat was his shrine to perfection, and I potentially had done damage to it, and that absolutely exacerbated the obsessions I was having about that and my need to check and recheck and to make sure that everything was okay. So I believe that environmental factors probably shaped the nature of our obsessions and compulsions, although I have no scientific facts for that, that’s just my own sense of things. So I’ve always said my dad didn’t cause my OCD, I don’t believe that for a second, but he certainly exacerbated the challenges.
Peter B. Collins: You describe on your 30th birthday, you and your wife Samantha, went to Hawaii for a nice celebration, and one of the factors was you rented a car and returned it missing a hubcap. And Jeff, again, I’m just sharing here, but I was in Italy a few years ago and I nudged another car that caused the front left to hubcap to fall off of my rental car. And I spent days trying to find a replacement because when you’re in another country, you turn in a car with any kind of damage, they take you to the laundry. And so for four days, I was all over the place looking for a single hubcap and couldn’t find it, and I ultimately bought four of the damn things because I couldn’t find one that matched the three remaining.
Peter B. Collins: And the night before I returned the car, I was out driving around on dirt roads to dirty up these brand-new hubcaps so they wouldn’t notice what had happened. Yours is an experience that basically led to a fear of driving and limited your own scope of travel to the point where you described that when you were sent out on a news assignment, you’d park the radio station car and hail a cab.
Jeff Bell: Yeah. And that really is, I think the epitome of my irony around what I do for a living. Let me share just a little bit about that driving. So I’ve battled what’s commonly called hit and run or harm OCD. It’s a subset, again, there are probably seven or eight primary subsets of OCD, this is a fairly common one. And my fear, my core obsession, always is this, what if through my negligence, I unknowingly harmed or might harm someone or something? Almost every obsession I’ve ever had falls under that umbrella. So what is my greatest opportunity every day to harm people inadvertently? It’s driving a car.
Jeff Bell: And so the irony for me as a field reporter, which is how I started at KCBS, I was a weekend anchor to fill in a reporter, I was tasked with driving to the scene of a breaking news story as efficiently as possible and getting there and telling the story. Well, for me the toughest challenge was not doing the reporting, that’s always come fairly naturally for me, it was getting there, because every time I ran over a pothole, my voice of doubt, my doubt bulliers as I’ve come to call it, would say, “Hey, what if that wasn’t a pothole, but somebody you actually ran over?” And I’m a reasonably intelligent guy, I think I know the difference between running over a pothole and running over a body, but as I often say, intellect is the bullied little brother of emotion, it doesn’t count for much in the throes of an anxiety attack.
Jeff Bell: So every time I’d run over a pothole, I turned the damn car around and drive back, I’d seen that there was a pothole in the road, that was a compulsion, I got that immediate relief from that compulsion that said, “Oh, there’s an explanation for the rattling car, it was a pothole.” I feel better, I drive off, maybe a half mile down the road, but that bully taps my shoulder and says, “Look, just because you saw a pothole, it doesn’t preclude the possibility that there was also a body.” So I turn the car around, I go back, I check again, I don’t see a body, I feel better. I think you see where this is going, it’s never enough.
Jeff Bell: I ultimately go back to make sure the body didn’t roll over to the side of the road, let’s just say it’s a really good thing that the CHP did not see me going through the bushes along interstate 80, “It’s okay, officer. I’m just looking for the body of somebody I might’ve run over.” That became my life. And so with this news car, yeah, you referenced that, it got so bad, Peter, that I started taking the KCBS News van out of the garage that would appear that I was doing my job in a normal way. I park it around the block and I take a taxi cab out to breaking news stories, because avoidance is the ultimate compulsion. And that’s what I started doing was avoiding triggering activities.
Jeff Bell: And of course, it was not a way out, it was also a very expensive way to do my job, but it was my attempt to get around the anxiety.
Peter B. Collins: Well, it reminds me of Bob Greene, who was a fairly famous newspaper columnist in Chicago, this was in the ’70s and ’80s, He just said, “I don’t drive” But he wants to reveal to me after several stiff ones that he was afraid and he didn’t delve into the origins of the anxiety or any more detail, but he spent his whole life using cabs and getting other people to drive him places, and often was kind of underhanded in the way he would con people into doing the driving.
Jeff Bell: Can I share with you what happens sometimes for those of us who try to avoid. So I went through that whole cycle of driving became so difficult that I told myself, “I’ll just give it up.” And that’ll be really clear, I will never be an Uber driver, I will never be a Muni bus driver. There were things that I could never do around driving. That said, I take great pride in the fact that I drive just about anywhere these days, I push myself to do that. But when I gave up driving, Peter, all of a sudden walking became next to impossible. When I would walk down a sidewalk and I would step on a twig, the thought would pop into my head, “Well, what if that twig now kicks up into the spokes of a bicycle and some kid goes flying over the handlebars because I inadvertently moved that twig from where it was on the sidewalk?”
Jeff Bell: And at my worst, I remember walking down the Embarcadero and picking up rock after rock after twig, I can only imagine what people were thinking as they were watching me walk down the street. This was pre-treatment and this isn’t a pretty bad stretch of my life, but walking became next to impossible as well. So sometimes when we run from the fear in an irrational way, we just find another set of challenges that go along with it, which is not to say that there are legitimate limits we might put on some of our most difficult challenges like driving.
Peter B. Collins: Seems like a displacement, it kind of shows that the original target was not necessarily the boogeyman.
Jeff Bell: Bingo. And that is the most profound thing that we touched on this entire time here. It’s never about the content as we say in the OCD advocacy world, the content is almost irrelevant. The whole boat thing, it wasn’t about the boat, the whole thing with potholes, it wasn’t about the potholes. It was at its core, the incredible discomfort of sitting with the anxiety. I’ve been in real accidents before, they’ve been easier for me to deal with than the hypothetical what if I inadvertently hit somebody? It’s the uncertainty that is just seemingly unbearable for those of us with OCD.
Peter B. Collins: Jeff, one more anecdote from the book, you were one of the reporters who covered the O. J. Simpson trial. And on your first afternoon in the courtroom, you seem to think that Judge Lance Ito was staring you down and thought you had horns or something.
Jeff Bell: This leads me to a comment that one of my therapists who actually did not diagnose the OCD early, one of the misdiagnoses came earlier from Dr. Y, as I call her in the book, I believe. She said to me, “You have a very inflated sense of your own power.” And in retrospect, that is one thing she nailed, those of us with OCD, want to give ourselves great powers, cause all kinds of mayhem for other people in our world. And yes, sitting in the O. J. Simpson trial room that day, I just rotated in one day. And that particular day, I was sitting in there, I was convinced I was single-handedly going to cause a mistrial. Yeah.
Peter B. Collins: Wow. So give us in a couple of minutes your odyssey through therapy and spend more time on the cognitive part and the breakthroughs.
Jeff Bell: Sure. I took a very circuitous path through OCD treatment, and I often say, and I mean this, there’s as much to learn from what I did wrong as to what I did right. So ironically, and actually that maybe it’s not so ironic, maybe it’s perfectly consistent with the OCD black and white thinking, I was convinced early on that if anybody ever knew that I was getting psychological treatment, that I was ruined, my life was over. I had this fantasy about a secret file that we all have and the only people that have access to that secret file are the people who have the ability to ruin your life. And I was convinced that my secret file had all kinds of damning information in there, or certainly would if I allowed myself to be open about this. I could’ve never imagined a conversation like this.
Jeff Bell: So when I first sought treatment, I very reluctantly went to see a psychologist, I call Dr. X in the book. And Dr. X asks a bunch of questions and I was very careful about what I let him put down on his little yellow pad because for that very reason about the secret file, and after about two or three sessions, Dr. X decided that he had come to a diagnosis. We had been talking about my fast track career and how well everything was going for me, and he just blurted out one day, “I think you have a fear of success.” And I’m thinking of psychiatric hang-ups, I go, “Hey, that’s a pretty noble one, I’m going with that.” I’m like, “Yes, Dr. X, I bet that’s it.” Of course, I knew it wasn’t. So I left Dr. X and I tried to soldier on my own for a while, but life was just spiraling out of control, my compulsions were just growing by the day.
Jeff Bell: So I went back to see a second doctor, Dr. Y. And Dr. Y was a traditional psychotherapist, and I have absolutely nothing against psychotherapy, it’s a wonderful, wonderful tool. In the OCD world, it is not the front line of defense. We’re going to talk about cognitive behavioral therapy in a minute, that is that front line of the defense, Dr. Y didn’t know that. So Dr. Y, who am I have affectionately dubbed, “Doctor, how does that make you feel?” And I did this dance every time I went in, I would tell her, I was a little bit more open this time, I was a little bit more open about my challenges and they were very clearly defined. I would tell her, “Gosh, Dr. Y, I keep driving my car around the block, or I keep checking and rechecking my appliances.”
Jeff Bell: Now, you or anybody else in 2020 would go, “Huh, I wonder if you might have OCD?” Well, Dr. Y was not that educated, certainly, back at this juncture. And so she would say to me, “Well, how does that make you feel in a very touchy-feely kind of way.” And I would say, “Ashamed, embarrassed, frustrated, anxious, blah, blah, blah.” But we did this dance over and over and over again, and then finally she stumbled across a treatment process that proved to be effective. She took vacation. Because while she was on vacation, my inner investigative journalist took over.
Jeff Bell: As you mentioned, I worked at a Channel 2 TV for a bunch of years and we were a stone’s throw away from Jack London Square, and there was, I want to say it was a Borders Books, maybe it was a Barnes and Noble, but there was this bookstore there. And I went into that bookstore and I was so fixated on what would happen if anybody saw me there, Peter, that I remember, I had a story in my head, I was prepared to tell everybody from Channel 2 who might see me there like, “Oh yeah. Tom’s been acting a little depressed lately, I want to see if I can find something for him.” I had thought that through. That’s how paranoid, if you will, I was about getting caught.
Jeff Bell: But I’m going through the book store, the psychology section, and nothing is seeming to fit, I’m not battling postpartum depression, I’m not looking at the loss of a loved one issues, that all of a sudden this book nearly jumps off the shelf at me, it’s called The Boy Who Couldn’t Stop Washing. And interestingly, I was not a washer in those days, that came later, but something about the words couldn’t stop, just really spoke to me. So I pulled a book off the shelf, I start reading it and lo and behold, and thank God for this, for my own selfish perspective, the very first story in that book is about a guy driving down a highway who keeps turning his car around.
Jeff Bell: I kid you not, Peter, my first thought is, “I don’t remember writing this book.”  It was amazing to think that anybody else might have been doing the same crazy thing that I was doing. So I read the book cover to cover in an aisle there in this bookstore. At this point, I am crying hysterically because I can’t imagine that as long as I live, I will ever have a more powerful moment than that one. In that moment I learned three things. One, I’m not the only person who does this, and that was the biggest thing. Two, there was a name for this thing, the author called it OCD, obsessive-compulsive disorder. And three, there was a treatment process for it. So I read the book cover to cover, I bring it home, I share it with my wife.
Jeff Bell: She’s crying now because she’s been through hell and back with me as well, and we feel like we’ve turned a corner here. I go back and see Dr. Y, she says to me, “OC what?” And I say, “OCD.” She says, “No, I don’t know about that one.” And I surprise myself by saying, “If you’ll excuse me, I believe it’s time to move on.” As I’m walking to the door, “I think you’d ask me now how I feel.” But Peter, she calls me the next day, and this could not have been an easy call for her. She calls and says, “I’ve been talking to some colleagues and there’s something to what you found, you need to explore that.” That was a big turning point. My next phone call was to what is now the IOCDF, and they pointed me to a cognitive behavioral therapist in the Bay Area, and I started getting the treatment that I needed.
Peter B. Collins: And Jeff, if I can put this in radio terms, you shifted from Dr. how-do-you-feel, to Dr. Laura?
Jeff Bell: Sure. There you go. Oh gosh, yeah. And shall I say a few words about cognitive behavioral therapy?
Peter B. Collins: Oh, please. Yes.
Jeff Bell: I’m going to ask you if you have time, but you keep reminding me that we’re not up against the network news coming up here.
Peter B. Collins: Go right ahead.
Jeff Bell: Okay. So CBT, Cognitive Behavioral Therapy. Basically, and this is alphabet soup, a form of cognitive behavioral therapy is something called Exposure Response Prevention, ERP. That is the gold standard for OCD treatment, and all that is, is a fancy name for learning to systematically address your compulsive actions. So we do everything on a hierarchy, if for example, the fear is that I’m going to catch something horrible by touching a doorknob, the therapist would ask me to build a hierarchy, “Thinking about that on a scale of one to 10 where is that?” “Oh, okay, let’s call that a two.” “What about actually coming near the doorknob and touching it with a paper towel?” “Okay, we’ll call that a three.” “How about actually touching it without the paper towel?” “We’ll call that a six.”
Jeff Bell: “And what if somebody sneezed on that doorknob as they walked by and now you’re going touch it?” “We’re going to call that a 10.” And so what we learn to do is work our way up that hierarchy by standing up to the compulsive urge. So we start with the lower ones, we start about thinking about the touching the doorknob, and then we touch it with the paper towel, and then we work our way up this hierarchy until we get through it. All we’re doing with this process is learning to sit with anxiety, because I referenced earlier with that pool analogy, that when you stay with anxiety, it dissipates. That is medical fact.
Jeff Bell: We have brain imaging studies that show, essentially think about putting me in a chair, not allowing me to do my compulsions, wiring up my brain so you can monitor it and getting me charged up with some obsessive thought and then watching the overheating in that part of my brain through the PET scan. The PET scan will show that if I just give it time and don’t act on the compulsion, the overheating will dissipate. So that’s what we’re looking to do.
Peter B. Collins: Now, Jeff, this strikes me as a slightly milder form of enhanced interrogation.
Jeff Bell: You might call it that, I call it torture therapy in my book. It’s not easy. So the good news and the bad news about OCD treatment, the good news is, it works. I’m here to tell you that.  I’ve got 10 years or more worth of evidence in my own world that people I’ve seen turn their lives around. The bad news is, it’s really tough work, you’ve got to stay motivated, you’ve got to. I looked for shortcuts for years and years and years and I couldn’t find them, although I sure tried. And there really is no shortcut around the need to sit with anxiety. That’s what it all boils down to. So that’s what ERP and CBT are all about.
Peter B. Collins: And Jeff, one of the symptoms, I would say, is that you were highly averse to using medication as part of the therapy.
Jeff Bell: Yeah. And that’s a really common roadblock for a lot of people. OCD is very much about control, and the lack of it for those of us who have trouble with uncertainty, which is just about everybody with OCD, that’s the hallmark. So we’re all feeling like we’re very out of control and we desperately want control, which is why we do these ridiculous compulsions, we feel like it’s going to give us more control. The irony with medication is that a lot of us start with this premise that we’re going to lose control if we’re on medication. That is not the case. And I remember a very profound aha moment with my wife when we had this conversation and I said to her, “I’m afraid this is going to change who I am, the medication.”
Jeff Bell: And she said to me in the most loving way, “Is this who you want to be?” And I thought to myself, “No.” And the medication, and I will be very candid about this, I have been on medication for most of the past, whatever it’s been since 2007 or a little bit earlier, not earlier than that actually. So it’s been quite a while, it’s probably been 20 years, and it has made a huge difference for me. Essentially, it lowers the volume of the what if questions, if you will. Now, I will put this out there because this is really important to me as an OCD advocate, I think that medication is one of the amazing tools that we are blessed with in the OCD community to address our disorder. I personally believe that medication without the cognitive behavioral therapy is sorting of setting yourself up for problems.
Jeff Bell: The CBT gives us tools, it gives us tools to navigate the challenges of living with obsessions and compulsions. The medication often helps lower that volume and is a great, great tool to help us do the CBT. But medication alone, I don’t recommend that personally, I really think that the CBT needs to be part of the mix.
Peter B. Collins: Well, Jeff, this is very powerful, you are remarkable in your willingness to share so much. And it moves me to hope that people who hear this are going to find commonality and maybe find some hope in your sharing of this very powerful and extremely personal story.
Jeff Bell: Well, I sure appreciate that, and I am happy to pass along an email for anybody who would like to get in touch.
Peter B. Collins: Go right ahead.
Jeff Bell: And ask any questions, I’m more than happy to do that. I am available online at jeffbellonline.com, and there is a Contact Me box on that. And I would be more than happy to, again, I’m not a medical doctor, I can’t answer any of those questions, but I’m pretty good at pointing people to resources. So come visit me at jeffbellonline.com.
Peter B. Collins: And I highly recommend the book Rewind, Replay, Repeat: A Memoir of Obsessive-Compulsive Disorder. Jeff Bell, I’ll see you on the radio.
Jeff Bell: Looking forward to it. Peter, thanks so much for the opportunity. I sure appreciate it.
Peter B. Collins: Thanks for listening to this Radio WhoWhatWhy Podcast. Send your comments to peter@peterbcollins.com. And if you can please chip in to support the investigative journalism work here at whowhatwhy.org.

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