The Man Who Couldn’t Stop (14 page)

I reversed that decision the day I made my baby daughter an accomplice. I telephoned my local doctor the next morning to make an appointment. It stopped here. It stopped with me.

 

EIGHT

Animals and other relatives

We think humans have free will. It's one thing that separates us from animals. We are masters of our biology, not the other way around. Yet there is something animal about OCD, something atavistic and primitive.

Videos surface from time to time on the Internet of people engaged in compulsive behaviour: postmen dip in and out of a box to check for letters with the same jerky repetitive movements that a wading bird uses when it ducks for fish.
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Drivers who return to check they locked their cars patrol the doors in the way that a bear lumbers around the perimeter of its territory. Just like humans, animals show common patterns of behaviour and ritual. They stop at the same places to eat, bathe and sleep. Some of this behaviour can appear compulsive.

In 1952, the Nobel Prize–winning Austrian zoologist Konrad Lorenz described how water shrews would travel along set paths ‘strictly bound to them as a railway engine to its tracks'. He saw how the shrews would jump over a stone that blocked their way, and how, when the stone was removed, they continued to jump. The animals, Lorenz said, would ‘disbelieve their senses' if those senses reported a need to change their behaviour. Of course we don't know what the shrews were thinking at the time, and because of this, some scientists in the OCD arena are sniffy about reading too much into animal behaviour. Repetitive actions are not necessarily compulsions, they insist. Compulsions are a response to an obsessive thought. There are some eerie similarities between rituals and compulsions, though. There is something very OCD about some animal behaviour.

The Japan Dog Festival is the country's largest and most prestigious show. Run by the Japan Kennel Club, it's a celebration of the pedigree of the nation's finest dogs and an excuse to watch them slalom through bendy poles and scamper around an obstacle course. The 2008 show was held at the Big Sight International Exhibition Centre in Odaiba in the run up to Christmas, and owners who attended had more to worry about than how their pets would fare in the festival's Agility Cup and the Champion of Champions event. A team of veterinary scientists from the University of Tokyo was there to ask how many of their dogs chased their own tails.

In the comics and cartoons of childhood, all dogs chase their own tails. Next to an appetite for slippers, it's a defining feature of the species. In the real world, while most tail-chasing is harmless, some dogs take it too far. They do it several times a day, and when they catch their tails they bite repeatedly until they make them bleed. Some scientists think such behaviour is the OCD of the dog world. They call it canine compulsive disorder.

Other animal rituals resemble the behaviours of OCD. One is compulsive grooming. Birds pick out their own feathers, mice and cats pull away their hair and dogs chew their fur. Dogs lick their paws until they are raw and inflamed. Horses show a damaging compulsive behaviour called cribbing, when they grip a fence or post with their teeth and pull their head back sharply, time and time again. Mice hoard marbles and other useless objects.

In animals, these routines are known as fixed action patterns – innate behaviour sequences triggered by specific circumstances and seen across a species, even in animals raised in isolation. They often emerge when the animal is under stress. Humans are not generally considered to exhibit fixed action patterns. But some of our behavioural rituals seem compulsive too. Look at the routines of sports stars under pressure: how tennis players must bounce the ball the same number of times before they serve, and golfers waggle the club as part of a familiar pre-shot routine before they swing to hit the ball. People in the shower often wash themselves in a set pattern. And just like Lorenz's water shrews, people heading from A to B like to stick to preferred paths.

Lorenz himself noted:

I once suddenly realized that when driving a car in Vienna I regularly used two different routes when approaching and leaving a certain place in the city. Rebelling against the creature of habit in myself, I tried using my customary return route for the outward journey and vice versa. The astonishing result of this experiment was an undeniable feeling of anxiety so unpleasant that when I came to return I reverted to the habitual route.

These are rituals, not compulsive behaviours. But they show that, just like animals, our motor response to some stimuli can be repetitive and patterned – just like the kinds of behaviour that can emerge in OCD.

Scientists think the behavioural rigidity of ritual is useful. It could help animals, and perhaps humans, to perform certain tasks with less mental effort, so allowing them to save precious energy to direct towards something else. In times of stress, that could help them survive. Here's a question – could OCD be what happens when this primitive process goes wrong? When it is deployed at the wrong time? When I put my baby daughter in and out of the swing, to check she had not caught HIV, was I responding to some ancient survival mechanism with ritual?

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The link between OCD and rituals intrigues scientists. Some human cultures certainly show behaviours that in another place and time would look like pathological compulsions. Nepalese Sherpas place 100 miniature clay shrines, 100 food cakes, 100 butter lamps and 100 dough effigies in a symmetrical pattern; the Gujars of Uttar Pradesh bathe and then make twelve offerings of red and white substances to twelve deities; the Moose of Burkina Faso sacrifice red, black or white chickens, depending on the situation; the Zuni native Americans make offerings at six points around their village while others take six puffs of special cigarettes and wave towards the six points of the Zuni compass. Apache Indians burn all clothes worn during the dressing and burying of a corpse, as a way to keep away intrusive ideas, images or words associated with the dead person.

One of the most detailed comparisons of human ritual and OCD was performed in 1994, when anthropologists published an exhaustive analysis of the complex initiation rite of the Bimin-Kuskusmin cannibals of Papua New Guinea. Highlights of the ritual see the boys told they are contaminated with female sexual fluids, before they have their heads covered in yellow mud and are told they will be killed or that something terrible will happen to them. They are sealed inside a house, coloured pigment smeared on their heads and faces and they are made to eat and vomit up specific foods that the tribe associates with women. More face smearing – sow blood this time – follows, and further taunting of contamination, of breast milk from infancy. The boys are cut and the blood applied to their penises. They are told this will destroy their penises, while their nasal septum is pierced. Hot marsupial fat is dripped onto their arms. The pus from their burns and blisters is collected and placed onto fruit being worn by their tormentors, who then chant sacred words, during which the boys are told not to swallow their saliva. When the chants finish, the boys must eat salt and pus, are painted again, and have their septum pierced again. They are cut twice more, with their blood placed this time onto the penises of the others. Almost done, the boys now eat five ‘male' foods, are painted again and anointed with fat, oil and boar blood. When they are not being cut, painted, pierced, burnt, insulted, force-fed or chanted at, each boy is locked away for days on end in a windowless hut with his own faeces, urine, blood and pus.

Looking at written accounts of the boys' ordeal, the anthropologists identified eleven separate OCD-like rituals, most of which occurred multiple times. They found concern with dirt, actions to remove contaminants, disgust at bodily secretions, numbers of special significance, fear of terrible events, repetitive actions and violent images – all of which are common features of obsessions and compulsions. One of the most regular ritualistic themes was a fear that something terrible will happen, specifically that someone would cause harm to themselves or others. In other words, most of the rituals in this ceremony reflected the theme of responsibility.

This research does not show that cultural rituals are a form of pathology, just as it does not suggest that OCD patients perform culturally significant rituals. Instead, the anthropologists suggest, humans may have a specific biological capacity for ritual, just as we do for language. In a few people this universal (and culturally acceptable) ability might malfunction, and lead them to construct meaningless and idiosyncratic (culturally unacceptable) rituals on their own. That would be OCD.

Other scientists have taken this idea further. OCD, they suggest, could be more than a basic capacity gone wrong. OCD might have once been useful. OCD might be a feature. The disorder might have evolved.

It's certainly tempting to see the main elements of OCD – wash, clean, check − reflected in ancient strategies that might have helped early humans or even earlier mammals to survive. Grooming strengthens social ties and could protect against disease, while checks on offspring, mates, territory and supplies would boost security. Those individuals who were the most aware of risk would be those least likely to succumb to hazards, and an ordered, symmetric environment is one easier to scrutinize for predators. If these traits were adaptive, if they once conferred a benefit that encouraged survival, then they would be more likely to spread through future generations. Anxiety is generally agreed to have evolved like this: The fight-or-flight response would have helped our ancestors to better respond to threat. The anxious man who runs away after he spots a lion in the distance lives to be anxious another day.

The problem with attempts to connect modern human behaviour to ancient scenarios and evolutionary processes in this way is that the link is very difficult to test – at least to the standards of proof demanded by those who protect the notion of evolution from what they see as abuse. The field – known as evolutionary psychology – hardly helps itself when it throws up headline examples that many choose to interpret as old excuses for modern bad behaviour: claims that men evolved to rape, for instance.

It's difficult to test the evolutionary basis for human behaviour, but it can be done. In 2005, scientists in London worked out a way to examine the evolutionary platform for anxiety. They looked at the details of a post-war UK birth cohort, 4,070 men and women born in 1946, and picked out two pieces of information about the participants: whether they were judged as anxious or neurotic as teenagers, and if they had died in an accident. The researchers found the least anxious adolescents were the more likely to die in an accident before they reached 25. High anxiety was associated with reduced accidents. The study concluded that anxiety protected young people, presumably because they were more reluctant to take risks.

The work was published in 2006 in the journal
Psychological Medicine
, and has a confounding – though so far unreported − postscript. William Lee, the psychiatrist who led the research, has repeated the study several times since with data from different birth cohorts, from people born in Aberdeen in the 1950s to Norway in the 1990s. None showed the same protective effect for anxiety. Lee struggles to explain the contradiction – perhaps the original study was a fluke, or maybe, because the number of fatal injuries in society has fallen, the effect is now too small to detect.

There are no comparable experimental studies to test if OCD traits improve the chances of survival, and it's hard to see how such studies could be done. But there has been plenty written about a possible evolutionary basis for OCD. Explanations like this in evolutionary psychology with no experimental backup are typically labelled ‘Just So' stories – a reference originally to the tales of Rudyard Kipling that explained, for example, how the leopard got its spots, but a term more recently used to criticize misleadingly simple explanations. When it comes to the possible link between evolution and OCD, the psychiatrists, psychologists and anthropologists who have discussed it are generally up-front about the speculative nature of their ideas. With that in mind, let's take a look.

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While anxiety is a response to a clear and present danger – the approach of a lion, say – the possible contribution of obsessive and compulsive traits to survival is more subtle. OCD is usually about threats that may occur in future – I wonder if there is a lion behind that rock? Still, this type of harm-avoidance might increase survival and so be passed on through evolution.

Some psychiatrists say OCD could have evolved as a psychological immune system. An individual with involuntary and repetitive thoughts about a concealed lion would experience fear and so develop a way to avoid the perceived threat, even if there was no lion there. In this way, obsessions could be ways to practise the response to threats without the risks of exposure to real-life danger. This advance preparation would give a clear advantage over others when the imagined threat became real. In this model, obsessions are akin to the antibodies generated by the physical immune system, a first line of defence prepared to counter a future threat. Compulsions are the behaviours learned to avoid or minimize the threat.

These obsessions may have been useful to early humans but, like all biological traits, they would not have been distributed evenly across the population. Just as the physical immune system can go haywire and attack the body's own cells, so some individuals could experience obsessions and compulsions in extreme forms that do more harm than good. In this way, OCD could be as much a dysfunctional by-product of (useful and adaptive) obsession, as generalized anxiety disorder today is a dysfunctional product of the (useful and adaptive) flight-or-fight response.

Psychiatrists have suggested another way that OCD could have evolved in humans: through a process called group selection – individuals who should perish because they carry traits that have a negative effect on them, but who get a free ride from evolution because those same traits benefit a wider social network. Group selection is controversial too – it seems to go against the every-gene-for-itself principle of the survival of the fittest – but there are some proposed examples, food sharing and cooperation between ants and honeybees among them.