Several months ago I broached the topic of OCD with a nonfiction read about hoarding. Because OCD is such a personal subject to me, I decided to devote this month’s nonfiction more fully to the illness with a read of David Adam’s “The Man Who Couldn’t Stop: OCD and the True Story of a Life Lost in Thought.”
For the average, non-ill person, it’s normal to obsess now and then. It’s normal to have a senseless fear (clown in the closet?), a sudden and unsettling urge that does not fit with who we are (swerve into traffic, perhaps?) or a good-luck practice not founded on reality (certainly no one believes that knocking on wood actually works, but… just in case.) It’s normal to be picky about your books lining up straight or to lose sleep one night as a worry goes round and round in your head like a circling predator. This is not OCD.
What really defines OCD is not the anal-retentive personality as pop culture has depicted it. It’s not about fussiness. OCD is about fear. For someone with OCD, their fears don’t live in the back of the mind like they would for the average person. They are solidly at the forefront, sprawled out over every thought. The urges that make up the “compulsive” part of “obsessive-compulsive” are the person’s attempt at alleviating those fears.
David Adam’s particular phobia is of AIDS, and on page 5 he perfectly illustrates that emotion with a narration of his thought process as he tries to deal with a cut on his heel in a public restroom:
Wait a minute. WHAT THE HELL HAD I DONE? I had put a paper towel on a fresh cut. OH JESUS CHRIST. There could have been anything on that paper towel, now soggy. THERE IS BLOOD ON IT. Well, of course, it’s my blood. HOW CAN YOU BE SURE? Someone with AIDS and a bleeding hand could have touched it before me. OH JESUS. I threw it into the bin, pulled a second from the dispenser and inspected it. No blood. That helped, a little. No blood on the next one either. BUT THEY COULD HAVE DONE. I pulled the original paper towel back from the bin. It was bloody. IF THIS IS SOMEONE ELSE’S BLOOD THEN WHY ARE YOU PICKING IT UP? I quickly washed my hands. AND WHAT IF THEY BLED INTO THE SINK TOO? DON’T TOUCH YOUR FUCKING HEEL. DON’T TOUCH YOUR FUCKING HEEL. DON’T TOUCH YOUR FUCKING HEEL. No chance of that. WHAT IF THAT ISN’T EVEN THE PAPER TOWEL YOU THREW IN THE BIN? It could be someone else’s paper towel that I was handling, someone else’s blood. I looked into the bin. I couldn’t see any other paper towels with blood on them. WHAT ABOUT THAT ONE?
This is what makes OCD so crippling, and not at all the “cute quirk” that mainstream culture believes it to be. On page 1, Adam describes a girl named Bira who compulsively ate a wall of her house, little by little. She was diagnosed with only moderately severe OCD. Moderately. Yes, it can get worse. A man named Marcus was so compelled to poke and prod at his eyeballs that he “prodded himself blind” (page 8).
Of course that is an extreme example. But even lesser extremes of OCD make life painful. Adam describes it on page 9 with a browser tab analogy:
Obsession is a large window that cannot be made to shrink, move, or close. Even when other tasks come to the front of the mind, the obsession window is there in the background. It grinds away and is ready to sequester attention. It acts as a constant drag on the battery and degrades the performance of other tasks. And after awhile it just gets really frustrating. You can’t force quit and you can’t turn the machine off and on. Whenever you are awake, the window is there.
Here’s an interesting factoid from page 10: “Obsess” as a word comes from the Latin obsidere, “to besiege.” Originally, to be obsessed did not mean to have a feeling of obsession towards something. The connotation was more alike to demonic possession – something obsessed YOU. This is remarkably accurate in what an obsession feels like, how it seems to invade the mind from the outside, bind the mind within its hold.
An intrusive thought is a thought that comes at you uncontrollably, may be repetitive, and is frequently upsetting. Pretty much everyone gets them on occasion. Thoughts like, “Imagine if I jumped from this 50-story building right now.” Or Adam’s example: “How easy it would be for me to stick this kitchen knife into him” (page 15). They freak us out because they don’t mesh with our identities. We would never stab him!! Never never!!!! How can we even think such a thing!!!!!!!!!!!
Perhaps the brain is driven to consider the despicable in order to process it, understand it, decide how we feel about it, then act accordingly (which is hopefully to not stick the knife in…) Perhaps it’s morbid curiosity. Perhaps our brains are just big jerks. With OCD, though, these intrusive thoughts are not merely occasional, but constant. A horror movie on loop.
Why? It’s not known for sure, but Adam explains the concept of a “cognitive idea generator” (page 22), the part of our brain that forms ideas. The rational part of our brain will discard the ideas that make no sense, but sometimes that part goes on vacation, and the idea generator is free to party it up. “Boss is out of the office! Woo hoooo!”
Let’s talk about another big part of OCD: checking.
Adam describes a woman who was so terrified of being buried alive that she left a plethora of notes around her house, instructing that upon her supposed death she was to be cut up into pieces. Afraid of dying in her sleep, she would check the location of these notes countless times before bed. “Sometimes she would spend so long on these pre-sleep checks that she never went to bed at all” (page 43). Another woman, deeply virtuous, was so afraid of accidentally stealing something that each day she would rub down her entire body, between every toe, finger, and fold of fabric, in search of hidden plunder (page 53).
Why perform these checks? Adam says, “To check, I thought, would make my life easier. Each time, I believed that one more time, one last check would give me the certainty I craved. But one check was never enough. Afterwards, each time, I doubted how thoroughly I had completed the check. So I would do it again” (page 76). Why is the brain unable to trust that the oven is off or the door locked the first time? Adam explains how the more a person does something, the more familiar it becomes, and the way the brain recalls familiar events is different from how it recalls novel ones. “It tends to focus on meaning rather than color and shape… This makes recall of familiar events less detailed. In OCD this means the more that we do something, the less sure we can be that we did” (page 78). Is that a cruel irony or what.
There is a TON more fascinating information in Adam’s book: different forms OCD takes, theories as to why it occurs… But I’m going to stop here, because this is a blog post and not a dissertation, and because I’d love for anyone curious about the topic to give the full book a read. It’s quite good.
And next time you hear someone joke about being “sooo OCD!” because they prefer to tie their right shoe before their left, please smack them for me.