The Man Who Couldn’t Stop (5 page)

Not surprisingly, HIV and Aids quickly replaced the Cold War nuclear threat – of the Frankie Goes to Hollywood song ‘Two Tribes' and Raymond Briggs's book
When the Wind Blows
– as the Great Fear of popular culture, and soaked through to the manners of day-to-day life. ‘A man round the corner in Boundary Lane has Aids,' my mother, not known for her mealtime jokes, announced to us one night in the late 1980s. ‘Yes, he's got one in each ear.'

Australia had it even worse. The government there screened a frankly horrific advert that showed HIV as a grim reaper who knocked down people – including a sobbing schoolgirl and a mother with baby – with bowling balls, and had their bodies dragged away as garbage.
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A generation was traumatized – as early as 1983, just a couple of years after HIV was identified, the first cases of what was then called Aids-phobia were reported – two men in their thirties, both with underlying mental conditions, who tested negative for HIV but were crippled by their fear of the disease. By 1987, so concerned that irrational obsessions with HIV were spreading faster than the virus itself, experts convened a special workshop in Munich to discuss ways to tackle the problem.

This reaction to the threat of HIV is an example of how obsessions can closely mirror society's fears and anxieties. In the 1920s, doctors in the US reported a surge in what they called ‘syphilis-phobia', which coincided with a campaign to highlight the dangers of the disease. In the 1960s and 1970s there was a spike in irrational fears of asbestos, just as the dangers of the material had come to popular attention. By the 1980s and 1990s it was HIV. The US psychiatrist Judith Rapoport wrote in her book
The Boy Who Couldn't Stop Washing
– which introduced many people to OCD – that by 1989 a third of her obsessive-compulsive patients focused on HIV and Aids. The disease, she wrote, appeared ‘so terrifying, so irrational that it could have been the creation of an obsessive-compulsive's worst fantasy'.

In this new century, society has a new topic to obsess it. In 2012 Australian scientists reported the first cases of obsessive-compulsive patients who fixate on thoughts about climate change – a bogeyman for the new millennium and one that, similar to Aids in the 1980s, poses an uncertain, universal threat, depicted in lurid detail by the mass media.
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Some of these people fear that increased temperatures will evaporate the water they leave out for their pet cats and dogs, and so they check the bowls time and time again. Others repeatedly make sure that taps, heaters and cooker are not left on, not because they fear the consequences for themselves, but because of the perceived impact of their negligence on water resources and greenhouse gas emissions, and so on the fate of the planet. One was obsessed with the idea that global warming would make his house fall down. He compulsively checked the skirting boards, pipes and roof for cracks, and repeatedly opened and closed its wooden doors to make sure that climate change had not brought a plague of termites.

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Psychiatrists have traditionally viewed OCD as an anxiety disorder, along with conditions like phobia. Certainly, obsessions can appear similar to phobias, which are likewise exaggerated and often irrational fears. The anxiety caused by OCD and phobia are the same, and so is the sense of helplessness and impotence, and the awareness on some level that it's all a bit silly. But people with phobias have one escape that those with OCD do not: they can usually avoid the stimulus that provokes their fear. Someone with an acute fear of heights can refuse to stand near the edge of a high bridge, or to walk along cliffs. Arachnophobia is only a problem for arachnophobes when they are in the presence of spiders. Someone with paraskevidekatriaphobia, a fear of Friday the 13th, is truly a paraskevidekatriaphobe for only a couple of days or so a year. In phobias, the feared stimulus is external. But in OCD it comes from within, from our own thoughts.

Obsessions and phobia can, however, focus on the same fear. In the 1980s, Andy Warhol had a persistent dread of HIV, which the artist called the ‘magic disease'. He refused to eat sandwiches prepared by another gay man and when his partner Jon Gould developed pneumonia in 1984, Warhol told his housekeepers to wash their clothes and dishes separately. Given what was known and not known about Aids at the time, it's hard to see Warhol's fear as completely irrational. He certainly didn't think it was. He didn't fight the thoughts. And that means that he probably didn't have OCD.

Overlap between phobia and OCD exists for a more primitive terror. In the early 1960s, clinical psychologists at a mental hospital in Warrington near Liverpool treated a middle-aged American woman obsessed with a fear she would be buried alive. To stop this from happening, the woman wrote detailed instructions of how her body should be cut up after her death and left several copies of these notes around her house so they would be discovered if she died. Each night she had to compulsively check these instructions were in place before she could sleep. Sometimes she would spend so long on these pre-sleep checks that she never went to bed at all.

Was her fear irrational? Like Warhol, the woman could have argued not. Her obsessions and compulsions began when she read a newspaper story of a man closed up in his coffin while he was still alive. Tales of premature burial were common in the past, and inventors fitted coffins with bells and whistles and other ways for the revived deceased to draw attention from underground. Many countries in Europe passed burial laws in the eighteenth and nineteenth centuries to ensure that corpses were kept above ground for enough time to give the not-really-dead time to come round.

George Washington and Frederic Chopin shared this fear of being buried alive – formally known as taphephobia – and it was common for people to include in their will requests for candles and mirrors to be held to their dead mouth to detect breathing, while others asked to be decapitated or stabbed through the heart before they were placed inside their coffin. The famous will of Alfred Nobel, the Swedish inventor of dynamite who pledged his fortune to set up the academic prizes that bear his name, ends with the words:

Finally, it is my express wish that following my death my veins shall be opened, and when this has been done and competent doctors have confirmed clear signs of death, my remains shall be cremated in a so-called crematorium.

Crematorium owners did well from taphephobia.

As well as being an obsessive-compulsive, the woman in Warrington was claustrophobic. She could not ride in an elevator or an underground train or sit in a locked room. The psychologists thought they could treat her compulsions if they eased her phobia. If she was not frightened of small and enclosed spaces, they reasoned, she would not need her grisly instructions and her nightly checks on them. They were wrong. Months of treatment at Winwick hospital, now a housing estate that overlooks the M62 motorway, cured her of the claustrophobia, so much so that she could sit inside a closed cupboard. But she never lost her obsessive-compulsive fear of an early grave, and could never sleep until she had made sure she would not wake up in one.

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Given cases like these, it's perhaps tempting to see obsessions and compulsions as a modern complaint, yet another manufactured condition of the pampered and self-indulgent postwar generations with little more serious to concern them than whether they left the gas on. But OCD, or something like it, seems to have troubled people for centuries.

For as long as people have claimed religious, scientific or medical authority, others have sought their help for distress caused by intrusive thoughts they cannot make go away. Yet in return religion, science and medicine have traditionally offered little comfort. If not burnt at the stake for witchcraft or forced into an exorcism to drive away controlling demons, people who reported odd thoughts have been locked up, declared mad, given huge doses of hallucinogenic drugs, shunned or had their brains blasted with electricity. Their intrusive thoughts were considered beyond the pale – they were the products of an impure soul, the work of the devil, the output of an evil heart or the function of a diseased mind. They were freakish, and those who had them were freaks.

Sigmund Freud had a different idea. Freud said that OCD was down to repressed guilt about childhood masturbation. Thanks Sigmund.

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Freud owes much of his fame and reputation to his work on OCD, or what we would today call OCD. He preferred the term ‘obsessional neurosis', and even he, no stranger to the weird ways of the human mind, found the condition bizarre. He once wrote:

 

This is a mad disease, surely … I don't think the wildest psychiatric fantasy could have invented anything like it, and if we did not see it every day with our own eyes we could hardly bring ourselves to believe in it.

Freud saw the mind as a fluid and interconnected bundle of experiences and motivations, some of which were apparent to the individual, and some not. Mental conflict – the suppression of sexual and toilet instincts in childhood, usually – would fester in the darkest corners of the subconscious. Psychological problems later in life were echoes of this original disturbance, he reckoned, the mental pings of a distress beacon buried somewhere inside the mind – even if they manifested themselves in quite different ways. To treat such a neurotic patient, Freud concluded, a doctor must locate, expose and disarm the buried trauma through psychoanalysis. They must talk to the patient about their childhood, their sexual experiences and their parents to ease the buried trauma to the surface. It has become the classic help of a psychiatrist's couch.

On 1 October 1907, Freud put onto his couch a 29-year-old Austrian lawyer and reserve soldier in the Imperial Army. The man was short and knock-kneed, with black hair, brown eyes, a sharp nose and an oval chin. He lived in Vienna and his name was Dr Ernst Lanzer. Lanzer's case became a sensation, yet the world would not know his identity for almost eighty years. Instead he was known by the dark alter ego that Freud's colleagues gave him, a name that scientists still use today and one that only hints at the swirling intrusive thoughts that drew him into the world of OCD and the waiting room of Sigmund Freud. Ernst Lanzer was the Rat Man. And the Rat Man, sadly, was a mess.

Lanzer told Freud how he was consumed by ridiculous ideas. He constantly worried that he would, without reason or intention, take a blade and cut his own throat. He feared terrible things could happen to his (already dead) father. Most disturbingly, his mind was filled with a sadistic vision that caged rats would be tied to the buttocks of his loved ones, and forced to gnaw through into their anuses.

Lanzer had become obsessed with thoughts of the rats while on a military exercise in Galicia that summer when a fellow officer described a grotesque Oriental torture technique. Historians have traced the story's origin to a popular book at the time,
The Torture Garden
, by Octave Mirbeau. In the book, a Chinese professional torturer describes his favourite technique:

You take a young man, as young and strong as possible, whose muscles are quite resistant … you undress him … you make him kneel, his back bent on the earth, where you fasten him with chains riveted to iron collars which bind his neck, his wrists, his calves and ankles.

Then in a big pot, whose bottom is pierced with a little hole, you place a very fat rat whom it's wise to have deprived of nourishment for a couple of days to excite its ferocity. And to this pot inhabited by this rat you apply hermetically like an enormous cupping glass to the back of the condemned by means of stout thongs attached to a leather girdle around the loins … You introduce an iron rod, heated red hot at the fire of a forge. The rat tries to escape the burning of the rod and its dazzling light.

In halting and emotional words, Lanzer told Freud that he could not dispel intrusive thoughts that the torture would be carried out on his girlfriend and his (dead) father. He would counter the obsessive thought with a compulsive response, always the same: he would say to himself ‘but' and then perform what Freud called a ‘gesture of repudiation' and then say ‘whatever are you thinking of'. Only in this way, he said, could he prevent the feared situation from happening. The thoughts of torture, he assured Freud, were foreign and repugnant to him.

The subsequent psychodynamic analysis that Freud performed – probes of the young Lanzer's sexual experiences and his awkward relationship with his father – seemed to help, at least according to Freud, who would later claim that he was able to completely restore Lanzer's personality by explaining to him the symbolic meaning of his obsessions with rats. These included associations between the rodents and money, his father's gambling, marriage and a childhood incident when Lanzer had bitten someone and been punished. The Rat Man, Freud concluded, was angry with his father and so unconsciously fantasized about having anal intercourse with him. Repression of this idea caused the obsession, Freud said. Making Lanzer aware of this, the doctor claimed, made the obsession go away.

By 1908 Lanzer had a stable job with a law firm, in 1910 he was married and in 1913, after the required six-year apprenticeship, he qualified as an attorney. Despite these successes, Lanzer's story has no happy ending. Called up to fight on the outbreak of war in August 1914, he lasted just three months. On 21 November he was captured by the Russians. Four days later he was dead.

By then, Freud was on the up. In the spring of 1908, he had caused a sensation when he presented Lanzer's case, and a story of how he had cured him, in a marathon lecture that opened the First Psychoanalytic Congress in Salzburg. Ernest Jones, a British psychologist who was at the meeting, later wrote:

[Freud] described the analysis of an obsessional case, one which afterwards we used to refer to as that of ‘The Man with the Rats'. He sat at the end of a long table along the sides of which we were gathered and spoke in his usual low but distinct conversational tone. He began at the Continental hour of eight in the morning and we listened with rapt attention. At eleven he broke off, suggesting that we had had enough. But we were so absorbed that we insisted on his continuing, which he did until nearly one o'clock.