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Book Review: The Man Who Couldn’t Stop

By (January 9, 2015) One Comment

The Man Who Couldn’t Stop: OCD and the True Story of a Life Lost in Thoughtman who couldn't stop cover

by David Adam

Sarah Crichton Books

Farrar, Straus and Giroux, 2015

According to popular British science writer David Adam, the complex of mental obsessions known as Obsessive Compulsive Disorder is as widespread as it is misunderstood:

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.

Though clearly and accessibly presented, statistics like those are intended to startle, and even from that one excerpt, it’s easy to see why The Man Who Couldn’t Stop: OCD and the True Story of a Life Lost in Thought has sold so well in the UK. Adam not only lays out plainly and energetically the current medical and social thinking on all aspects of OCD, but he adds throughout his own story of struggling with OCD for two decades. The personal angle allows Adam to assume a more immediate, less clinical tone when trying to describe what it feels like to be in the grip of seemingly irresistible compulsion:

In the grip of a compulsive urge there is nowhere to hide and nothing to reason with To resist a compulsion with willpower alone is to hold back an avalanche by melting the snow with a candle. It just keeps coming and coming. The obsession and compulsions of OCD are linked by a force of nature so strong that to break the connection demands almost supernatural effort. When I was in the grip of the worst OCD, if you had asked me not to investigate the suspicious red stains on a communal towel, you may as well have ordered me to fly or to shoot thunderbolts from my fingers.

Skeptical readers will instantly spot the difference between Adam’s two examples, since Adam isn’t physically capable of shooting thunderbolts from his fingers, whereas, however difficult or distracting, he is in fact able to stop himself from investigating suspicious stains on a towel. This is the apparent contradiction at the heart of OCD and the main thing that makes it so difficult for so many people to grasp: it’s an affliction whose sufferers can overcome its outward symptoms by trying really hard. You may want with an overwhelming desire to count the stairs you’re climbing; you may insist to yourself and others that you can’t climb those stairs unless you count them – but in fact you can, in a way very different from what would happen if, for instance, you tried really hard not to be schizophrenic.

The science of OCD is maddeningly murky, and it must be said that Adam brings no light to the subject. It’s singularly unhelpful to rattle through the long list of historical figures he does; what bearing does it have on the subject of OCD, for example, to inform us that both George Washington and Frederic Chopin shared a fear of being buried alive (“formerly known as taphephobia,” Adam industriously informs us – industriously but erroneously, since like all other phobias, taphephobia is the persistent, irrational fear of being buried alive, from which neither Washington nor Chopin suffered)? These attempts to legitimize OCD by giving it a deep history are doomed to invalidity by the fact that they can never be verified, so why not stick to the enormous modern-day caseload? Lord knows, the subject attracts skeptics enough as it is.

The Man Who Couldn’t Stop will do a good deal to soften that skepticism, although as usual in writings on the subject of OCD, the results of independently-verified studies are undifferentiated from the results of phony studies financed and promulgated by some subsidiary or other of GlaxoSmithKline, which makes roughly $300 billion every year by manufacturing the “serotonin reuptake inhibitors” they then tout as effective counter-measures to OCD (and which also spends a relatively paltry $25 million flying unethical psychiatrists to “conferences” in places like Hawaii, Tahiti, and Bali and making sure their cabinets back home are well-stocked with samples of the current drugs they’re marketing)(their out-of-court one-time-only gag-ruled cash settlements to the grieving loved ones of their victims can’t be estimated but can be assumed to be less than a blip on their annual tax deductions). This kind of murkiness is even less forgivable than the other on Adam’s part, and the distracting maneuver is a predictable one: dramatically describe the barbaric “treatments” of earlier ages, like partial lobotomy:

Lobotomy has a dreadful reputation and one that it fully deserves. In the middle decades of the twentieth century, tens of thousands of people with OCD and other mental illnesses had their brains irreversibly damaged by cavalier surgeons armed with nothing more precise than knitting needles. Hammered up through the tops of the eye sockets, the solid metal was then waggled – there is no other term – around in a clumsy attempt to sever bits of the frontal cortex. Some improved. Plenty didn’t.

“Mental health professionals refer to OCD as a secret disease and a silent epidemic,” Adam writes with moving sympathy:

The number of people who report obsessions and compulsions to doctors is routinely much lower than the studies of their prevalence would suggest. A lot of people with OCD choose to suffer in silence. Their thoughts are their dirty little secret.

I myself have never encountered anybody suffering from even the smallest touch of OCD who had any tendency to be silent about it; ten out of any fifteen people I meet on any given day loudly claim to be suffering from this serious mental disorder Adam describes – three out of ten practically introduce themselves with it, “Mary Adams, OCD, pleased to meet you.” This, too, is an annoying side-effect of the disorder’s nebulosity: it’s hugely easy to fake, and Adam is piercingly insightful on the fact that this only serves to isolate even more cruelly those whose brains genuinely are locking them into obsessive behavior-loops. In The Man Who Couldn’t Stop, those genuine sufferers will find a book that speaks directly to their daily misery – and maybe even offers them a bit of hope.