The Man Who Couldn’t Stop (2 page)

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It is hard to communicate obsession – severe, clinical obsession, a true monopoly of thought. Just as the human brain struggles to comprehend the magnitude of geological time, or the speed at which electronics can operate, or even the number of times a second the wings of a hummingbird can beat, so it can seem incredible that a single notion, a unique concept, can truly dominate someone's mind for days, weeks, months, years. Here is the best description I have.

Consider a personal computer, and the various windows and separate operations that the machine can run concurrently. As I write this, there is another window open in the background that updates my email, and a separate web browser that, right now, tracks sports scores. When I choose, I can toggle between these windows, make them bigger or smaller, open and close others as I see fit. That is how the mind usually handles thoughts. It shares conscious concentration between tasks, while the subconscious changes the content of each window, or draws our attention among them.

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 a while 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. And when you do manage to turn your attention elsewhere, you are aware that you deliberately do so. Soon enough, the obsession will reclaim the focus. Sometimes, usually when you wake, it is absent. The screen is blank. But push a key, move the mouse, engage the brain, and it whirs and clicks back into place.

As recently as the 1980s, psychiatrists thought that clinical obsessions and compulsions were extremely rare. They believe now that between 2 per cent and 3 per cent of people suffer from OCD at some point in their life. That means more than a million people in Britain are affected directly, and five million more in the United States. OCD is the fourth most common mental disorder after the big three − depression, substance abuse and anxiety. OCD is twice as common as autism and schizophrenia. The World Health Organization has ranked OCD as the tenth most disabling medical condition. Its impact on quality of life has been judged more severe than diabetes. But people with OCD typically wait a decade or more before they seek help.

OCD affects men and women equally. It begins usually in early teens or late adolescence and early adulthood, though its effects can last a lifetime. It respects no cultural, ethnic, racial or geographical boundaries. OCD is a social handicap and a societal burden. Children with OCD are more likely to want friends, but less likely to make them. Adults with OCD are more likely to be unemployed and unmarried. They drag down their families. They are more likely to live with their parents. They are more likely to be celibate. If they do marry, they are less likely to have children. They are more likely to divorce. Yet many front-line doctors still fail to recognize the signs and symptoms of OCD or their significance. Few people with OCD spontaneously recover, yet two-thirds of sufferers never see a mental health professional.

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The word ‘obsess' first appeared in English in the early 1500s. Drawn from the Latin
obsidere
, literally ‘before to sit' but more commonly defined as ‘to besiege', the term has a military background. To obsess a city was to surround but not yet control it. The related
possidere
, from which we derive posses and possessed, described the subsequent stage, when a victorious army would take control of the city and conquer its people.

The drift of these words to describe troubled individuals, first in religious terms and later in clinical language, carried the same distinction. The original use of ‘obsess' reflected the belief that the strange thought – in those days attributed to an evil spirit – originated outside the victim. To be obsessed was something that happened
to
someone; a person was not obsessed with an idea – it was the idea that obsessed them. This was different from someone who was possessed, when the spirit was thought to invade and control a person from the inside.

A diagnosis of whether someone was obsessed or possessed by evil spirits often came down to whether the victim was aware of the malevolent presence; whether they recognized their thoughts as alien and so tried to resist them. Those who were obsessed were considered able to do this. Victims of possession, because they had surrendered their soul to the invading demons, were not. They remained unaware of what was happening. The distinction survives to this day. A diagnosis of OCD usually requires a degree of what psychiatrists call insight – an obsessed person must identify the strange thoughts that drive the obsession as foreign and distressing and must make efforts to reject them.

Today, ‘obsession' is a more widely used word. Because thoughts usually come and go, the head a constant swirl of involuntary emotions and sensations, it takes only a drag of coalescence of this mental stardust around a recurrent theme to form a temporary lump, a sticking point, that society calls an obsession. In this way, people say they are obsessed when they cannot get an attractive person out of their minds, or when they cannot quell thoughts about a certain food. Our minds are so fluid that any sluggish current draws our attention. We say we obsess about sport, sex, shoes, cream buns, cars and a thousand other pleasures, sometimes all at the same time. But in time, often no time at all, these so-called obsessions break away and are carried off and consumed by the mental stream. That is not the obsession we will talk about here. It would not make somebody eat a wall.

The obsessive thoughts of OCD are different and tend to cluster around a limited number of themes. Obsessions of contamination with dirt and disease are the most frequent and feature in about a third of cases. Irrational fears of harm − did I lock the back door? Is the oven switched off? – are the next most common, and affect about a quarter of people with OCD. About one in ten wrestles with an obsessive need for patterns and symmetry. Rarer, but still significant, are obsessions with the body and physical symptoms, religious and blasphemous thoughts, unwanted sexual thoughts, and thoughts of carrying out acts of violence. It's because obsessive thoughts are so often within these taboo and embarrassing subjects that so many people with OCD choose to hide them.

Obsession has no regard for rational explanation. No pathology of thought can be solved with more thought. The brilliant twentieth-century mathematician Kurt Gödel, a friend and colleague of Albert Einstein, lived his life for rationality. His incompleteness theorem used logic to explore and expose the limits of logic. Yet Gödel suffered from the wildly irrational and obsessive idea that he would accidentally be poisoned, from tainted food perhaps, or by gas that escaped from his refrigerator. He would eat no meal that his wife did not taste first. When she became ill and could not do this for him, the obsessive siege on his mind made Gödel starve himself to death.

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Why I am writing this book? Obsession encourages attention to turn inward and drains focus from relationships with others. OCD cements the presence of an individual at the centre of their mind and their actions. And it distracts. There is always something else that you would rather think about, or not think about. I don't want to be selfish any more. I now have two children who need me. I don't want them to go through what I did. I don't want them to develop obsessions, to be held hostage by their strange thoughts, to think up a monster. And if they do, I want to be able to help them.

The best way to do that, I believe, is to investigate these strange and obsessive thoughts, to see how they work, where they come from and what we can learn from them. To question how the brain, our closest ally and biggest asset in millions of years of evolution, can turn against us so. To see what forces to the surface the obsessive Mr Hyde who lies dormant inside every Dr Jekyll − inside you − and how his betrayal can be stopped. And, as it turns out, it is a terrific story.

Strange thoughts, the seeds of obsession, are everywhere. They scatter across the population. Yet only occasionally do they take root. The first step in our journey to understand obsession is to see how this happens.

 

TWO

Bad thoughts

‘How easy it would be for me to stick this kitchen knife into him.' Most people have thoughts like that. They are called intrusive thoughts. Most people don't talk about their intrusive thoughts.

They don't talk about them, that is, until psychologists take the trouble to ask. When they do, then survey after survey shows that about nine in ten people admit they experience intrusive thoughts that distress, bewilder, shock and perplex them. Most people have thoughts about driving their car off the road. A third of us say we have thoughts of grabbing money. More than four in ten get an urge to jump from a high place, an impulse so common that it has its own scientific name: the high-place phenomenon. Half of all women and eight out of ten men have thoughts of strangers in the nude, while half of all people cannot help but think of sex acts they consider ‘disgusting'.

Intrusive thoughts are everywhere. But it took until the late 1970s for anyone to notice, when the South African-born psychologist Stanley Rachman and his Sri Lankan colleague Padmal de Silva made a stunning discovery. In trying to understand the nature of obsession, the two realized that many normal people seemed to have the same kinds of strange thoughts and impulses as patients with OCD.

Their obsessive-compulsive patients had urges to insult and physically attack people, but so, it turned out, did their friends. The patients reported impulses to push people under trains and buses, to jump from high places and to deliberately crash their car. So did their colleagues. Both groups had ideas of violence during sex, had thoughts that they might have committed a crime they heard about on the news and harboured irrational fears that they might have suffered some contamination, such as from radiation or asbestos.

When the psychologists wrote down the weird thoughts harvested from the minds of their OCD patients and those from their ‘normal' associates on index cards, and mixed the cards up, even their most experienced clinical colleagues could not correctly distinguish which thoughts came from the damaged minds of patients considered mentally ill and which came from the highly respected people they worked and socialized with.

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My OCD began with an intrusive thought, a snowflake that fell from the summer sky. ‘Shall we go upstairs?' the girl had asked me. She was pretty, with long black hair that she had to push back from her eyes as we kissed. The skin on her arms was smooth and her hands, I remember, seemed so small. She was older than me, though she didn't think so. Her question: ‘You're not a first year are you?' hadn't left me much room to manoeuvre. I had lied about my university course too. I knew nothing about the politics of the French Revolution but it sounded of more appeal to her than chemical engineering. I knew little about chemical engineering either, but then I had only studied it for a couple of months.

I was eighteen and a happy college student. Real life was on hold and time was a string of fun nights and daytime lectures on fluid dynamics and mathematics. I had little idea what a chemical engineer did, but I didn't care. That was the future. And right now it felt good to think about only the next day.

It was November 1990 in northern England so she wore a baggy white T-shirt with a purple skirt over Doc Marten boots and black leggings. I was pleased with my newly-grown sideburns. I thought she might mention them as we stumbled through the dry sand of our early conversation. By the time we headed from the university campus and into the neighbouring maze of terraced houses I realized that she wasn't going to. We walked and we talked, about music and our friends. We reached her house and, as she invited me inside and closed the front door behind us, a new world beckoned.

It was one of those frozen Leeds nights that Yorkshire folk are so proud of. The wheezing gas fire in her kitchen generated more light than heat and the cold chased us around the room like the smoke from a wood fire. Upstairs sounded good.

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‘Did you have sex with that girl?' my friend Noel asked the next day.

‘Yes,' I lied.

‘Did you use a condom?'

‘No.'

‘You could have Aids.'

‘Don't be daft.'

Had I had sex with that girl? No. Had we used a condom? No. Could I have caught Aids? Don't be daft. Still, I hadn't even considered the threat, despite all of the warnings. I should be more careful next time, I thought as I bought Noel a drink that night. I should have been more careful. The same thought, an echo of our conversation – you could have Aids – floated back into my mind from time to time over the next few months, but on each occasion I could muster the mental puff to blow it out. Don't be daft. Then, one hot night in the August of 1991, I couldn't.

On holiday from university as I walked back to my parents' house, with no warning the thought came again. You could have Aids. Only this time I couldn't move past the idea, or the cramps of panic it caused. ‘Don't be daft' suddenly seemed an inadequate response to the scale of the threat, the possible consequences. I could have Aids. And if I did, then I was doomed. My life was over before it had truly begun. Worse, no matter what I did, no matter what anybody said, I could not change it. They could not fix it. I had lost the power over my own fate. As I tried to brush away the thought, the snowflake, it squirmed from my mental grasp and settled. Quickly it was joined by another, then another, then another. The blizzard that followed blew the snow into every corner of my mind, and laid down a blanket that muffled every surface.