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This book, subtitled An OCD-Inspired Approach to Living with Uncertainty, is a follow-up to author Jeff Bell's fascinating memoir about his struggles with Obsessive-Compulsive Disorder (OCD), Rewind, Replay, Repeat. In When in Doubt, Make Belief, Bell presents the specific strategies which he found to be most helpful in confronting the fears and uncertainties produced by his OCD, sometimes referred to as the "doubting disease." As psychiatrist Michael Jenike suggests in his introduction to this volume, there are many effective treatments for OCD, but what is sometimes lacking is the patient's own investment in the treatment process. Through his uniquely personal perspective, Bell describes how he himself found ways to reclaim control from the Doubt (with a capital "D") which had come to rule his life.
In the first part of the book, Bell provides an excellent feel for the experience of living with OCD. He begins by offering an extremely helpful distinction between healthy forms of doubt, which involve reason and logic, versus unhealthy doubt. He also reviews some of the key hallmarks which distinguish obsessions, and he explains exactly how the "obsession--distress--compulsion--relief" cycle of OCD works. Finally, in describing the most common compulsions, Bell utilizes the useful metaphor of "trapdoors" which the OCD sufferer is at risk of falling into; these most frequent trapdoors include checking, reassurance-seeking, ruminating, protecting, fixing, and avoiding.
Part 2 is the "Making Belief" section of the book. Here Bell presents ten specific steps for getting out of doubt, a model which he developed based on the "Structure of Belief" pyramid that he first shared in Rewind, Replay, Repeat. Bell focuses on the four levels of the pyramid--reverence, resolve, investment, and surrender--and he offers several principles associated with each tier. For example, for reverence, he talks about making the choice to view the universe as friendly, embracing possibility, and affirming your own potential. The concept of investment most directly addresses motivation, with Bell encouraging readers to exercise freedom to choose, including choosing to direct one's attention and choosing to act for the Greater Good. The Greater Good then becomes the central focus in the final part of the book. Bell argues that what is missing in traditional OCD treatment models is the motivational component; he maintains that professionals need to give patients a reason to confront their worst fears. The reason which Bell develops is what he calls his "Greater Good Perspective Shift" (GGPS). He suggests that in the minds of those with OCD, there is a "Doubt Bully" who argues that the "good" choice is the one which offers short-term anxiety relief (i.e., giving in to a compulsion, or falling through one of the trapdoors listed above), whereas the "bad" choice is to sit with and tolerate the anxiety. By using the Greater Good framework, however, one can produce a GGPS to reframe and refute the work of the Doubt Bully, thus creating motivation to resist the compulsion.
Throughout the book, Bell weaves in interviews with experts in OCD and related fields. He also includes many personal stories--some readers may remember Carole from Rewind, Replay, Repeat, and she is joined by several others, including Jared, Sarah, and Amy. In addition, Bell concludes with profiles of several inspiring figures: there are those whose own lives have been touched by mental illness, such as Patty Duke, and those who have dealt with doubt as part of their professional careers, including Leon Panetta and Dr. Lewis Nerenberg. Bell effectively uses each interview to further illustrate and expound upon his concepts. In the end, this is an extremely hopeful and encouraging work, not only for OCD sufferers, but also for anyone who has been plagued by the anxieties, fears, and worries which stem from doubt.
© 2010 Beth Cholette
Beth Cholette, Ph.D., is a clinical psychologist who provides psychotherapy to college students.
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