When your thoughts become fears and your fears become obsessions

Washington Post illustration

THE MAN WHO COULDN’T STOP: OCD and the True Story of a Life Lost in Thought

By David Adam

Sarah Crichton/Farrar Straus Giroux. 324 pp. $26

Linger for a moment on those irrational thoughts that sometimes hop the mind’s rope line. What would happen if I drove against traffic in the thick of rush hour? What if my completely healthy loved one died tomorrow? Or if I got too close to that ledge, might I jump off?

Imagine now that the thoughts are not quickly cast out, but instead claim more and more space until they overwhelm everything else, all but the awareness that you can’t stop them. Trying to banish them only ensures their persistence. Some people develop distractions — compulsive, repetitive behaviors — to fight back. But the compulsions aggravate the obsessions. Being caught in this destructive loop is what it means to live with obsessive-compulsive disorder.

“In the grip of OCD, there were times when I wanted to tear my skull to reach inside and rip the thoughts from my brain,” British journalist David Adam writes in this searing account of the malady. “I was desperate to find the cells that held the intrusive thoughts and to squeeze them between my fingers until they burst.”

Often dismissed as a behavioral quirk (the office worker who keeps her cubicle spotless is “a little OCD”), this is a crippling illness, Adam writes, “defined as much by the mental torment of recurring strange thoughts as physical actions such as repeated hand-washing.” Adam, an editor at the journal Nature, knows this terrain well. He’s been battling his tormentor for more than two decades.

The mental-disorder memoir — mixing first-person confessional, scientific survey and cultural history in varying doses — has become its own genre, and works such as Elizabeth Wurtzel’s “Prozac Nation,” Andrew Solomon’s “The Noonday Demon” and most recently Scott Stossel’s “My Age of Anxiety” set a high standard. In “The Man Who Couldn’t Stop,” Adam more than meets it, writing with honesty, compassion and even humor about a malady so often stigmatized and caricatured.

Sarah Crichton/FSG

Lest anyone think OCD is a first-world disorder stoked by pharmaceutical companies, Adam finds OCD throughout the globe and across the centuries. There is Bira, the Ethiopian schoolgirl who could not stop thinking about the mud wall of her house, so she started eating it. “By the time she was 17 years old,” Adam writes, “she had eaten eight square metres of the wall, more than half a tonne of mud bricks.” Or Mademoiselle F. in early-19th-century France, who constantly worried that she had stolen something. She became reluctant to handle any money, in case she might drain its value; she wore her shoes too tight so she could not place items inside them; she constantly checked the folds of her clothes for anything she might have taken. After 16 years of this, she committed herself to psychiatric help. “My preoccupation is absurd and ridiculous,” she said. “But I cannot prevent it.”

Fears of contamination through dirt and disease are recurring OCD preoccupations, Adam notes, as are worries of unlikely harm, the incessant need for patterns and symmetry, unwanted sexual thoughts, and fixations on religion and blasphemy. In a fascinating chapter titled “The God Obsession,” Adam explains how “OCD and religion have walked hand in hand through the centuries.” In faith traditions that emphasize purity of action or thought, or that overburden believers with guilt and responsibility, it is not hard to make the leap.

OCD fears often reflect the anxieties of the time. Today, Adam reports, there are cases of climate-change OCD: people concerned that their pets’ drinking water will evaporate and check it constantly, or those who worry that their homes will fall apart and perpetually monitor pipes and roofs for cracks.

The author’s own OCD became clear when he was a college student in 1991. He bragged to a friend that he’d had sex with an older female student, even though he hadn’t. “Did you use a condom?” the friend asked. When Adam said no, his friend planted a worry that would grow and endure for decades: “You could have AIDS,” he said.

No matter that Adam had lied about the encounter. “I could have AIDS,” he would think. “And if I did, then I was doomed.” The idea overpowered him. He dialed the National AIDS Helpline dozens of times each day. He donated blood as often as possible, just for the HIV test. “The blood donor service would take it only every sixteen weeks,” he recalls. “I would count down the days in a planner.”

Adam began to see the risk of HIV on toothbrushes, towels, telephones. He recalls the torrent of thoughts after scraping his heel as he walked barefoot at his gym. “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. YOU STUPID BASTARD. I looked at the 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.” (Adam knows that his fears about AIDS are cemented in how he saw the virus in 1991 — an immediate death sentence born of a moment’s carelessness — not as it is far better understood and treated today. But that realization changes little.)

It was many years later, when his baby girl became part of his obsessions, that Adam sought help. He saw a smear of blood on her leg and realized it came from a small cut on his hand: “It could be someone else’s blood. And it could be HIV-positive. She could have rubbed it into her eyes. . . . She could have AIDS.”

His varying treatments reflect constant shifts in scientific theories about the origins of OCD. One psychiatrist told Adam to wear a rubber band on his wrist and snap himself whenever he thought about AIDS. SSRI drugs such as Zoloft, Prozac and Lustral help a majority of people with OCD but have no effect for up to 40 percent of them, Adam reports. They do help him, making his thoughts less “sticky.”

The history of OCD treatments also includes aversion therapy — a patient in the 1970s had electrodes strapped to his fingers, for example, delivering a shock if he washed his hands too often — and a brutal track record with lobotomies. Modern surgical procedures target smaller portions of the brain, Adam explains, but “the principle of psychosurgery has remained the same for more than a century: let’s cut here and hope for the best.”

He is more sympathetic to cognitive behavioral therapy, which enlists a patient’s obsessions in the fight. In one session, Adam rubbed his eyes, then worried that, because he was in a hospital, some contaminated blood could have made it onto his hands. He desperately wanted to check his fingers, but the therapist urged him instead to rub his eyes again. Adam refused, but he managed to not examine his hands. It took three days for his anxiety to subside. “Three days felt like three years,” he said. “But three years is pretty quick for an extinction event.” He now knew that fear could peak, then ebb. This was progress — especially with an illness whose patients devote an average of 10 hours a day to their obsessions and compulsions.

Freud, no surprise, believed that OCD is caused by repressed guilt over childhood masturbation. (“Thanks Sigmund,” Adam deadpans.) There are also evolutionary and hereditary explanations — highly speculative ones, Adam cautions. Physical trauma, such as a motorcycle accident or a botched surgery, has also been linked to OCD, he explains, while MRI scans connect the disorder with unusual activity in the basal ganglia, a part of the brain involved in controlling movement and learning routine behavior.

But is OCD really a matter of the brain, with its circuitry and chemicals, or of the mind, the realm of human consciousness? Adam writes that some people with mental illness prefer to blame the brain, absolving themselves of responsibility. “I prefer the opposite explanation,” he concludes. “That my brain is normal, thanks. The drugs help to keep its complicated and volatile chemistry on track, but it’s my mind, my brain’s lodger, which has the OCD. . . . My mind today is different from what it was yesterday; I have learned new things and forgotten others. The ephemeral mind is flexible in a way that the material mind is not.”

In a life lost in thoughts, Adam finds a hopeful one.

Read more from Book Party:

Inside the mind of the Pentagon’s “Yoda”

Did Nixon blow off his daily CIA reports?

The time Obama walked in on a staffer who had a friend in bed

Cornel West channels Martin Luther King Jr. to criticize Obama