Cardiovascular diseases are the leading cause of death in the United States. Two of every five Americans will develop cardiovascular illness in the form of high blood pressure, a heart attack, a stroke, or other vascular disease. Until now, however, treatment consisted largely of systematic relief; prevention of the primary cause of the illness was not terribly important. It has long been known that dietary factors, especially a high-fat, low-fiber diet, are the major cause of cardiovascular illness. This correlation was first confirmed about eighty years ago by an experiment involving rabbits fed a high-cholesterol diet. Rabbits eating high amounts of cholesterol were later found to have atherosclerosis. Although research had also focused on the link between heart disease and diet, specifically the fat and cholesterol content, major breakthroughs today show that vitamins, minerals, and other nutrients can have a dramatic and very positive impact on cardiovascular disease. Antioxidants like beta-carotene and vitamins С and E hold great promise in the fight against heart disease.

It took a long time for the medical profession to consistently inform patients that a high-fat, high-cholesterol diet leads to the development of cardiovascular illness. For decades now, the total blood cholesterol has been part of most laboratory blood diagnostic analysis. Recently, attention has been given to the various lipoproteins that carry cholesterol throughout the body. These tests also have become very commonplace in the usual blood diagnostic work-up. The most exciting aspect of this research has focused on the reaction of free radicals with low-density lipoprotein cholesterol (LDL cholesterol), or, as I commonly tell my patients to remember it, the “lousy cholesterol.” Free radicals are highly unstable because of the way in which their electrons behave.

They can effect dramatic changes in the molecules with which they react. Free radicals, particularly the oxygen free radical, have recently been shown to change the LDL cholesterol molecule. Once changed, it assumes different properties that promote hardening of arteries. This modification is known as oxidation.

*44\360\2*

Feats of wisdom (or on a humbler scale, displays of expertise) usually strike an awed observer as a near-instantaneous, seemingly effortless “knowing” of the solution to a seemingly thorny, unexpected problem. Wisdom is also the ability to anticipate the events that catch most people completely unaware. We have already established that the phenomenon of wisdom, with all its complexity, cannot merely be reduced to the capacity for high-level pattern recognition. But we have also established that such pattern-recognition capacity comprises a very important element of wisdom, which implies that a person endowed with wisdom has the ability to recognize an unusually large number of patterns, each encompassing a whole class of important situations. As we already know, this ability is the result of a large number of attractors stored in one’s brain. It takes time for the pattern-recognizing attractors to accumulate and form. The patterns that enable us to find quick solutions to a wide range of problems are generic memories. The arsenal of these generic memories accumulates with age.

Also accumulated with age is the facility for intuitive decision-making. Intuition is often understood as an antithesis to analytic decision-making, as something inherently nonanalytic or preanalytic. But in reality, intuition is the condensation of vast prior analytic experience; it is analysis compressed and crystallized. In effect, then, intuitive decision-making is postanalytic, rather than preanalytic or nonanalytic. It is the product of analytic processes being condensed to such a degree that its internal structure may elude even the person benefiting from it. The “postanalytic” nature of intuitive decision-making was pointed out by Herbert Simon.

The advantages of such mental condensations were “discovered” by evolution millions of years ago and have been utilized across generations of various species. Certain agents in the environment, like a snake, are “recognized” as danger through an instantaneous, automatic, extremely efficient process not requiring any deliberation. One can think of this mechanism as a form of “phyletic” wisdom, a notion introduced by Joaquin Fuster and discussed in an earlier chapter. Like every highly generic mechanism, phyletic wisdom is statistical in nature. It works to our advantage most of the time, maybe the overwhelming majority of the time, but not always. And it operates with the near-absolute force of a hardwired mechanism, which it is. The seat of this hardwired, automatic response mechanism is in the amygdala, a small collection of nerve cells found on the inside of each temporal lobe.

I came to fully appreciate the force of such hardwired decision-making condensations on a trip to Kenya many years ago. Among many other things that tourists do, I visited a crocodile farm, where a just-hatched baby crocodile was proffered to me. The tiny creature was barely the length of my palm, skinny and obviously harmless. Yet as I extended my arm to touch the creature (a conscious process directed by the neocortex), an unfathomable force pulled my arm in the opposite direction away from it (an automatic process directed by the amygdala). I was witnessing this neural tug-of-war with utter disbelief and with an odd feeling of being a passive observer of the inner workings of my own brain, rather than their empowered agent. To my amazement, the amygdala prevailed and I found myself unable to touch the baby crocodile. From a rational standpoint, the situation was utterly ridiculous, but the hardwired mechanism, honed through generations of species, had the last word. A similar reaction to snakes has been reported by a number of people; and I must admit to a bit of a shiver every time I see a large snake suspended from the shoulder of a street entertainer, a scene not uncommon in many urban environments. The thought of approaching the creature and touching it never crosses my mind, even remotely.

Just as the amygdala contains neural condensations embodying the phyletic wisdom that developed over millions of years, the neocortex contains neural condensations that embody individual wisdom (or competence) developed through the lifespan. These condensations come in the neural forms of the attractors that we discussed before. Just as in the case of my baby crocodile, filtering information about the world through such cognitive templates may occasionally misfire. But on the whole they are extremely adaptive.

The intuitive decision-making of an expert bypasses orderly, logical steps precisely because it is a condensation of extensive use of such orderly logical steps in the past. It is the luxury of mental economy conferred by vast prior experience. The great physicist Richard Feynman was reportedly able to scan several pages densely covered with arcane mathematical formulas and casually conclude: “Looks about right.” Effortlessly postanalytic!

A simple, everyday illustration of mental economy conferred by previously accumulated knowledge is found in our ability to read the newspaper without, strictly speaking, reading it. I open an issue of a major newspaper circa the end of year 2003 and skim through the headlines: Milosevic HI Again… Schwarzenegger Gaining… Bali Bomber Sentenced… I do not need to read the whole articles to know their content. My previously accumulated knowledge about current events allows me to infer the content with such great accuracy that if I were to actually read the reports word for word, I would not have learned much more than I had already inferred. The war-crimes trial of the former Yugoslavian president Slobodan Milosevic has been put on hold again because of his claim of poor health. The bodybuilder-turned-politician is ahead in the California gubernatorial race. The trial of the Muslim fundamentalist who blew up a discotheque in Bah is finally reaching a conclusion.

I would have been able to extract all this information without the prior knowledge too. But then I would have had to read the news reports very closely. I would have spent at least thirty minutes, maybe an hour, extracting the information from the text, and the process would have taxed my attention, memory, and linguistic abilities. But with the benefit of prior knowledge, the whole process boiled down to near-instantaneous recognition, was marvelously effortless, and took all of thirty seconds. Here is mental economy for you! Of course, my newspaper example is a far cry from decision-making in demanding, complex situations. But the principle of previously accumulated patterns serving as the mechanism of mental economy operates in a fundamentally similar fashion across various, seemingly very different situations.

The neural benefits conferred by such mental economy are considerable, and their value to the individual increases with age. To understand why this is so, the notions of “mental reserve” or “mental resources” are often invoked, and it is assumed that they tend to dwindle with age. These concepts have gained prominence among neuroscientists concerned with cognitive aging, despite their somewhat mysterious ring. This reflects an attempt to capture some elusive aspects of the mind, which in the lay parlance are referred to as “mental energy” or “clarity of thought.” Frankly, I have always felt that “mental resources” is one of those terms that creates the illusion of understanding through the invention of a new name for an old quagmire. (There are plenty of those in science!)

We don’t know exactly what determines the amount of “mental resources” in a given individual. By way of sheer speculation, it could be the amount of oxygen made available to the brain through the bloodstream, the density of neuronal connectivity, the speed of electric signal transmission along the axon, the concentration of critical neurotransmitters in the synapse, or the combination of all of the above. Whatever is behind it, the amount of “mental resources” varies from person to person. But the mental economy, made possible by the mechanism of pattern recognition, enables a person to solve very complex mental tasks with a minimum expenditure of mental resources. Effectively, mental economy inherent in pattern recognition counteracts the decline in mental resources presumed to take place in most people as they age.

A lazy, untrained, and “unpatterned” mind is sometimes seduced by the apparent ease and effortless nature of “postanalytic” decision-making and is tempted to emulate it. Far from being postanalytic, such a pathetic display will most assuredly be “fake analytic.” A recently fashionable educational trend teaching grade school and high school mathematics through impressionistic quantitative “estimations” rather than explicit computations is the worst example of such a cognitive fake.

*29\302\2*

Mildred was 80 years old and had had BDD for nearly 70 years, since she was a teenager. “I’ve always felt homely and ugly,” she began. “It’s shameful to have these concerns, because they’re so superficial. It shouldn’t matter…. Now I realize how excessive and unrealistic they were. When I see pictures of myself, I think I didn’t look so bad back then. It doesn’t bother me so much now; it was at its worst in my teens and twenties. But I’m still too concerned with how I look.”

Mildred grew up in a small town in the Midwest. She described some of her early memories. “There was one main street in town. It was a very small place. I remember sometimes crossing the street to avoid people because I was so ugly. I was always very self-conscious, and I thought people talked about me. I always had the feeling that my mother and her friends talked about how I looked. I remember that when I was very young, one of my cousins commented on how homely I was. Now I think it was just sibling rivalry, but at the time I was devastated. I also remember being told that I looked like my mother. She wasn’t a good person, and I thought she was unattractive. I hated it when people told me that I looked like her. I hated to be identified with her.

“I used to wish I were black so I wouldn’t have freckles, and I used freckle cream. When people commented on my nice hair I felt bad because it meant I wasn’t otherwise attractive. I disliked myself so much I can’t imagine people liking me in any way. I didn’t feel desirable in any way. My feelings about my appearance were all tied up with feelings of inferiority: I was convinced people thought I was ugly—that I wasn’t likable or lovable.

“Seventy-five percent of my life has centered on how I look. I fought back. I tried not to let my appearance concerns interfere much with my life. But high school was an especially hard time. I missed parties, and I was very shy on dates. And I think I might have done different things with my life if I hadn’t been so preoccupied. I did raise wonderful daughters, but I would have had more energy for them and for other things, like my music. I think my concerns also affected my personality. People thought I was aloof, but I cared so much about what people thought of me. I was very easily hurt, very sensitive.

“I feel very guilty about my focus on my looks, because it seems so self-centered. There are other things to think about. I’ve never even told my husband about it, even though we’re close, because I think he’d think I’m foolish. I was in therapy for many years, but I never brought it up because it would have been too difficult. I was afraid my therapist would think I was superficial and concerned with unimportant things. I felt so ashamed, especially at my age. I feel I should have enough wisdom not to care about something so silly.”

*163\204\8*

After a cardiac event, a true psychiatric emergency is uncommon, but, naturally, when it does occur, it is crucial that it be treated. For practical purposes, we describe a sequence of urgency, although it does not necessarily develop in such a systematic way. There may be fleeting thoughts, persistent thoughts, a plan to act and finally the urge to commit suicide. If thoughts of suicide are persistent, a physician should be consulted within the day; if there is any plan or urge to act, proceed to the nearest emergency department. Help is always available, and treatment is effective.

A not uncommon scenario with cardiac patients is the sudden development of acute panic with the fear that one is going to die or lose control or go crazy. This may be accompanied by chest pain, palpitations or other physical symptoms. Patients must be examined by a physician. In the case of cardiac symptoms such as chest pain, cardiac disease must be ruled out—on an emergency basis, if necessary. If cardiac disease as a cause is ruled out, a panic attack is a possibility. There is excellent treatment available for this.

*94\214\2*

Planning on working on that sun-tan sometime this year? Before heading out, consider these facts and precautions.

Tanning and the anatomy of a burn

Ultraviolet A (UVA) and В (UVB) rays tan, burn, and age the skin. Tanning is how the skin protects itself from damage. UVA rays darken melanin grains in the epidermis, the skins top layer. After a few days, newly pigmented skin cells, stimulated by both UVA and UVB rays, migrate to the surface. UVA rays are weaker than UVB rays, but more of them reach the earth and penetrate the dermis, or deepest layer of skin. Over time, exposure can break down collagen and lead to wrinkles. UVB radiation is the main cause of burns and skin cancer. These shorter-wavelength rays have more energy than UVA rays, damaging cells in the epidermis.

Time of day

How long you’re in the sun matters, but so does time of day. Burning is more likely between 10:00 a.m. and 3:00 p.m. when less ultraviolet energy is filtered out by the atmosphere.

Cloud cover

Clouds let 80 percent of UV rays through and increase exposure by scattering the rays. It’s important to use good protection on cloudy days.

Peak protection

At high altitudes more UV rays get through, and snow reflects 80 percent of sunlight. Wear protective clothing and a high-SPF sunscreen.

In the water

UV rays can burn parts of your body that are underwater, so use waterproof sunscreen. Wearing a shirt while swimming and wading is advisable, because UV rays reflected off water and sand intensify exposure.

Sunglasses

Shades not only cut glare but also reduce the risk of UV-caused cataracts.

What to wear

An ordinary T-shirt has an effective SPF of only 6 to 8, dropping to 4 or 5 when wet. The more opaque the material, the fewer UV rays get through. Color doesn’t matter. Special sun-blocking clothing has an SPF of 30 or more.

Sunscreen tips

Apply an SPF 15 or higher sunscreen to the entire body 15 to 30 minutes before going out. Use at least a full ounce. Reapply even “waterproof sunscreen if you’re in the water longer than 80 minutes, towel off, or perspire heavily. Recent reports have highlighted the potential harmful effects of the active ingredients in sunscreens (oxybenzone), particularly after repeated applications. The concern is over the fact that this chemical is absorbed in the body and may have long-term negative effects.

*27/277/5*

Hyperacute Bacterial Conjunctivitis

Because of the rising prevalence of penicillin-resistant N. gonorrhoeae, ceftriaxone (Rocephin), a third-generation cephalosporin, is currently the systemic drug of choice. Ciprofloxacin can be used in patients who are allergic to penicillin. The eyes should be lavaged with saline as well. Concurrent treatment for presumed infection with C. trachomatis should also be performed. Physicians should ask about partners who might be infected.

Acute Bacterial Conjunctivitis

Acute bacterial conjunctivitis is likely to be self-limited in most cases, but treatment can shorten the clinical course and reduce person-to-person spread. Erythromycin ophthalmic ointment or sulfacetamide ophthalmic drops are effective initial choices. Ophthalmic fluoroquinolones are not first-line therapy because of bacterial resistance and cost. Aminoglycoside drops or ointments are not recommended because they are toxic to the corneal epithelium and can cause a reactive keratoconjunctivitis after several days of use.

Chlamydial Conjunctivitis

Adult inclusion conjunctivitis is treated orally with erythromycin or doxycycline for 7 to 14 days. Tetracyclines should not be administered to pregnant women. Adjunctive topical erythromycin ointment may be of benefit. The treatment of sexual partners helps to prevent re-infection.

Viral Conjunctivitis

There is no specific antiviral agent for the treatment of viral conjunctivitis. Contact lens use should be avoided until the eyes are without discharge and no longer red. The use of warm or cool compresses may provide additional symptomatic relief. Some patients feel improvement with topical antihistamines and decongestants, which are available in over-the-counter formulations. Physicians should explain that these agents treat the symptoms but not the disease. Patients should further be told that irritation and discharge may get worse for 3 to 5 days before improving and that symptoms can persist for up to 3 weeks.

Allergic Conjunctivitis

Over-the-counter topical antihistamines or decongestants are reasonable first-line therapies for symptomatic relief. Systemic antihistamines and decongestants are of little benefit in allergic conjunctivitis, since they tend to dry the ocular surface, exacerbating the sense of irritation.

Non-specific Conjunctivitis

Symptomatic relief of nonspecific conjunctivitis may be achieved with over-the-counter topical lubricants (artificial tears or ointments). Topical ocular ointments provide long-lasting relief but can blur vision, so they should be used at bedtime. Return to Work or School

Bacterial and viral conjunctivitis are both highly contagious. Infected individuals should not share towels, handkerchiefs, or other linens and should carefully wash their hands with soap and water after any contact with their eyes. Patients should be isolated from school or work for 1 to 2 weeks after the onset of symptoms.

*33/348/5*

Compresses

When children develop weepy eczema, cool compresses will help dry out the infection. Compresses may be simply made with vinegar diluted one in ten with water.

This solution should be kept in the fridge and applied as a cold compress for ten to fifteen minutes every four to six hours.

Antibiotics

Because eczema is itchy, it frequently becomes infected through constant scratching. Oral antibiotics are very useful, and are much more effective than topical antibiotic ointments. Eczema will often dramatically improve when treated with antibiotics.

Antihistamines

Oral antihistamines are useful as a sedative for both children and adults with eczema. They do not treat the eczema but do help to decrease itching during the night. Topical antihistamines, however, should be avoided as they can cause allergic dermatitis and make the condition worse.

Oral cortisone

Oral cortisone medication should only be used for very severe cases of eczema as it produces internal side effects such as growth retardation, especially when used for long periods. If oral cortisone is needed it should be used for only a short time and only where there are no other therapeutic options.

Mittens

Parents sometimes have their children wear mittens to prevent scratching. However, while a child may not be able to scratch his or her eczema, he or she may rub it instead, which causes thickening of the skin. It is more important to treat eczema successfully than to simply prevent scratching.

Other treatments

In recent years the use of vitamins and Evening Primrose Oil has been advocated for the treatment of eczema. Recent scientific studies, however, have shown that these are of little, if any, benefit.

*10/150/5*

The Carbohydrate Addict’s Diet allows you to change your eating habits without depriving you of the foods you love in the quantities that satisfy you.

It’s simply a matter of biology. People who are not carbohydrate addicts feel satisfied after eating. That’s because their metabolism responds in two ways to the food they take in: first, insulin is released so that the body can use the food energy that has been consumed; and, second, it releases the brain messenger serotonin in quantities great enough to issue the “stop-eating” order.

We now know that in the carbohydrate addict these mechanisms malfunction. We devised the Carbohydrate Addict’s Diet in order to correct these malfunctions. If these malfunctions are not corrected, the carbohydrate addict can expect to continue to feel hunger or recurring cravings, to feel unsatisfied, and to regain weight that has been lost.

Because there are so few rules, it is very important that you follow them exactly. Most dieters have very little trouble in doing so because the diet suits them and addresses their needs. The diet itself makes it easy to follow. You will not feel deprived.

In fact, you may not even feel like you are on a diet—but don’t be fooled. The diet won’t work if you don’t follow the basic guidelines.

Guideline #1: Eat Low-Carbohydrate Meals Daily

When you keep the carbohydrate intake low during your Low-Carbohydrate Meals, your body responds by producing and releasing less insulin. Less insulin means less hunger, fewer cravings, and a feeling of satisfaction. Best of all, a lowered level of insulin prods your body to take fat out of storage and to use it.

It is important to create a daily routine, in which the same two meals are designated as your Low-Carbohydrate Meals. The foods that you eat at these meals must be low in carbohydrates. We have found that many of our most successful dieters eat their Low-Carbohydrate Meals at breakfast or at lunch. In the next chapter, we will give you detailed advice in planning for your Low-Carbohydrate Meals.

In general, your Low-Carbohydrate Meals should consist of average servings (about four to six ounces) of meat, fish, or fowl, or two to three ounces of cheese, and roughly one and one-half to two cups of vegetables or salad. These meals will satisfy you and help you to lose weight while keeping your insulin levels low. Low-Carbohydrate Snacks (Plan A) are equal to about half the quantity of Low-Carbohydrate Meals.

Yet we all desire—and need—carbohydrates as part of our daily food intake. These needs are met by the Reward Meal.

Guideline #2: Eat a Reward Meal Every Day

Once a day at your Reward Meal, you can eat any food you desire (allowing for any dietary limitations imposed by your physician). All foods are allowed at the Reward Meal, and quantities are not limited, though your Reward Meal should be nourishing and well balanced.

Some of the people we have worked with are concerned when they first hear that Reward Meal quantities are not limited. They do not realize that when people are deprived of insulin-releasing carbohydrates for two consecutive meals, their bodies appear to adjust. The body comes to expect the food in the Low-Carbohydrate Meal; it will not be expecting a heavy carbohydrate load.

Having been fooled by two consecutive Low-Carbohydrate Meals, the body will release far less insulin than if you had been eating carbohydrates at every meal. An entire chain of metabolic events is changed, too: less insulin is released; less fat is stored; and more fat is used up. The lowered level of insulin also allows the brain chemical, serotonin, to act as it should—as an appetite regulator. You will probably eat far less than you would if you had been eating three consecutive carbohydrate-rich meals.

We have to be careful, however, because the body has a way to compensate for an unexpectedly high intake of carbohydrates, a sort of double-check mechanism. As we continue eating carbohydrates, a second phase of insulin is released.

But there is a way to control this second insulin release and to keep the insulin level low. It is the Reward Meal’s one-hour time limit.

Guideline #3: Complete Your Reward Meal Within One Hour

It all has to do with timing. The second phase of insulin release occurs about one and one-quarter to one and one-half hours after you begin eating. This insulin release comes from a reading made by your system as to how much carbohydrate you have eaten at that meal.

If you are still eating at that point, seventy-five to ninety minutes later, the amount of insulin in the second release will compensate for its original low release. Conversely, if you have finished eating, this second phase of insulin release appears to be kept low.

So a very important guideline to enjoying the Reward Meal is a time limit: you may eat whatever you desire, in whatever quantity you wish, but you have to complete that meal within one hour.

Guideline #4: Consume All Alcoholic Beverages During Your Reward Meal

Alcoholic beverages such as beer, wine, and cocktails can be enjoyed during your Reward Meal. If you have a favorite wine, save it to enjoy immediately before or along with your Reward Dinner. Be sure to finish your drink, and your meal, within the 60-minute time limit.

Some of the people we have worked with have found ingenious ways of dealing with prolonged cocktail parties by choosing club soda or diet soda until they were about to begin their dinner. They were then able to indulge themselves with their favorite wine, beer, or mixed drink without fear of recurring carbohydrate cravings or of gaining weight.

So buy the wine that you enjoy, or mixings for your favorite drink, and save them for your Reward Meal hour.

Guideline #5: Absolutely No Between-Meal Snacking Is Allowed

Even small quantities of carbohydrates can stimulate insulin release—and a few nibbles of potato chips or a single piece of chocolate can produce powerful cravings for more carbohydrates.

One piece of fruit, eaten other than during your Reward Meal, can reverse the whole metabolic process that is emptying your fat cells. That apple or banana or whatever can be the difference between weight loss and weight gain. Even low-carbohydrate foods should not be eaten between meals.

If you’re thinking this might be a problem, remember: the Carbohydrate Addict’s Diet will cut your desire to cheat or to snack between meals.

*28\236\2*

it is a fact that minimal instruction in behavior therapy can be all that is necessary for dramatic improvement in OCD. This has been demonstrated by psychiatrist Isaac Marks of the University of London. Marks, widely regarded as the world’s leading expert in behavior therapy, demonstrated in 1988 that OCD sufferers taught the basics of behavior therapy could do just as well as patients who made frequent and lengthy visits to behavior therapists. Marks observed that the key to improvement was patients engaging in exposure and response prevention by themselves. This agrees with a common clinical observation: Once patients learn how to do behavior therapy, they don’t need to come in for regular visits any more. Raymond told me, “Once I got the hang of exposure and response prevention, I was able to handle things by myself.”

This being true, I have no doubt that many cases of OCD do not require professional help. What is necessary is only to understand the principles of behavior therapy and to put them to use.

You may benefit from a self-help approach if you are a self-motivated person and if your symptoms are relatively mild. You should consult a therapist, on the other hand, if your obsessions, compulsions, or avoidance are causing major distress or disruption to your life, or if your OCD resembles the cases described above in which behavior therapy is especially difficult. It may well be helpful, if you are going to attempt to treat yourself, to pick up a book that deals with self-help in greater detail than I do here.

The following six steps cover the essential ingredients of effective behavior therapy for OCD. A note of caution: Isaac Marks comments that using self-treatment is far from a “glib exercise” in using willpower to face up to fears. Progress depends on mastering definitions and principles, then putting them to use in a systematic and disciplined way. That said, here is a bare-bones self-help program for OCD:

Step 1. Understand that your OCD is a brain disorder. What you are fighting is a chemical problem that makes certain fearful thoughts (obsessions) stick tenaciously. The discomfort caused by these thoughts forces you to perform silly, repetitive acts (compulsions) and to limit your life (avoidance).

Know these facts so well that you can explain them to others. Test yourself: What is OCD? What exactly are obsessions, compulsions, and avoidance?

Step 2. Fully grasp the principle of habituation, nature’s way of getting rid of fearful thoughts. Your job is to put habituation to work through the use of exposure and response prevention.

You will know that you have the main idea when you are able to comprehend this concise statement: “The problem with compulsions is that they chase away obsessions before a person habituates to them.”

Step 3. Make a list, at least mentally, of your obsessions, compulsions, and avoidance. Give them a general ranking according to how seriously they interfere with your life. (If clearly identifying obsessions and compulsions proves very difficult, which it is in some types of OCD, then you should see a professional.)

Step 4. Your goal is to learn to live with obsessions—even though you dislike them intensely—while combatting compulsions and avoidance. To accomplish this, do an exposure and response prevention task at least three times a week. Pick an instance of compulsion or avoidance that is relatively mild, set up an exposure situation, and tolerate the ensuing anxiety until it decreases by at least 50 percent, which may take up to one to two hours. As you “get the hang of it,” move on to more difficult tasks. (If you find that your anxiety is getting worse rather than better, you may be sensitizing to your obsessions rather than habituating. See a therapist.)

Step 5. Get support. You may be a lone-ranger type, but it is extremely helpful to have contact with other OCD sufferers and to keep abreast of new developments in OCD research. An excellent way to do this is to join the OC foundation .

Step 6. Try out different strategies to assist in exposure and response prevention.

*27/338/2*

Diwan Daulat Rai was a well-known land lord of a township. He was educated, honest, humane and very sympathetic and helpful to less fortunate people of his area. Naturally he was very popular amongst his people.

When the time came for municipal elections, the fans of Diwan Sahib forced him to stand for election, assuring him that his success was sure, as nobody would dare stand against him and if somebody was foolhardy enough to do that mistake, he was sure to lose his security deposit.

But this proved to be only wishful thinking. Against him stood a candidate from the ruling political party who had at his beck and call all fair or foul means to win an election. Some voters were purchased, some overawed by hired muscleman, and some ballot boxes were tempered with the connivance of the police.

Diwan Daulat Ram lost the election, and was so overwhelmed by the result that he took to the bed. He would not move out and refused to see any visitors. Day & night only one idea circulated in his mind “What did I do to, deserve this ignominy: To rid Diwan Daulat Rai from the mental torture the following medicines were prescribed:-

(1) VINE REMEDY as a constitutional medicine for his positive Vine type nature.

(2) STAR OF BETHLEHEM for the mental shock.

(3) WHITE CHESTNUT for the same idea repeating hi his mind again and again.

The above medicines taken three times a day restored Diwan Sahib to normal condition in 2 weeks.

*195\308\8*