The Man Who Couldn’t Stop (15 page)

To combine group selection and evolutionary psychology puts an idea on the slenderest of scientific thin ice, but psychiatrists in Canada have speculated that OCD represents an ancient form of behavioural specialization – a form of group selection suggested for insects that live in complex social structures stratified into distinct groups such as workers and drones. The majority of human compulsions – checking, washing, counting, hoarding and requiring precision – the psychiatrists say, could have benefited ancient human societies, especially hunter-gatherer communities, even if they had a negative impact on the individual.

Take checking. In his 1960 book,
Pygmies of the Ituri Forest
, the Harvard University anthropologist Patrick Putman wrote of Congo people who did not know how to make fire. They placed great importance on the need to keep several fires alight across the countryside so one group could always borrow fire from another. ‘While on the march,' Putman wrote, ‘the pygmies carry glowing embers with them; they can keep a brand lighted for ten miles during a rainstorm.' In this scenario, someone with a compulsive urge to check, to make sure their fire or carried embers was still alight, could be useful. The compulsion could give them and their wider group a tiny edge in the race to survive, and, repeated often enough, that could be enough to see it passed on.

Compulsive washing could be beneficial too. People with obsessive-compulsive demands for more rigorous hygiene could have influenced the behaviour and so the survival of entire tribes. The Waica people, for example, an isolated jungle tribe who live along the border of Brazil and Venezuela, will only drink water brought from upstream of any fords. That makes sense now, given what we know about infectious bacteria, and any hiker who has scooped to drink from a babbling mountain brook knows the sickening feeling when they discover upstream the rotten carcass of an animal. But how could the Waica's ancestors have known about this risk? People who get ill from contaminated water do not typically show symptoms straightaway, and this makes it difficult to associate one with the other. Could the practice instead have started with an irrational obsessive-compulsive action that stuck because it happened to benefit the tribe in the long run?

The actions of a small number of obsessive-compulsive people in such societies, the Canadian psychiatrists suggest, could have spread and raised sanitary standards, and so improved the health and survival chances of the entire group. It's a long shot, but can we rule it out? It would certainly be a mistake to assume that OCD could not present itself in this way, even in such a primitive people. Charles Seligman made such an assumption, and history will not let him forget it.

Seligman was a British anthropologist who visited the islands of Melanesia at the start of the twentieth century, and famously declared its native people free of mental disorders, except where there was obvious pressure from Europeans. Later work overturned his claim, and found that schizophrenia, for one, was as common there as everywhere else. Seligman, it was widely assumed, had falsely attributed the weird behaviour of mental illness, which he must have seen, to eccentric local custom. In anthropological circles a tendency to confuse the signs of mental problems in foreign parts with bizarre and alien cultural behaviour is now known as Seligman's error.

*   *   *

In the search for a possible evolutionary explanation for OCD, in recent years scientists have focused on another primitive drive, an emotion we share with animals and one that could misfire to produce obsessions and compulsions: disgust. Disgust probably evolved as a way to stir nausea and so protect us from illness and disease – picture your favourite delicacy rotten and covered with maggots and see if you feel like eating.

This ‘core' disgust extends to other sources of dirt and possible infection too: rats, for instance, and an unflushed toilet. There are two other disgust domains. One is animal-reminder disgust – revulsion at objects and acts that show us our mortality and animal origins, including aversion to mutilation, injury and some sexual acts: incest, perhaps, or even just a man in his twenties who has sex with an 80-year-old woman. People tend to describe that as ‘disgusting' rather than ‘unusual' or ‘not for me, thanks'. The third disgust domain is contamination, the fear we could catch an infectious disease from another person. Think how you feel when someone coughs over you.

All three types of disgust are powerful sensations and strong drivers of behaviour. When authorities in Ghana wanted to improve public hygiene, they broadcast television and radio adverts that graphically highlighted the way faecal material could stick to people's hands after they had been to the toilet – and how they could then transfer it to food eaten by children. The campaign provoked a 13 per cent rise in the number of people in Ghana who said they washed their hands with soap after they used the toilet. The number who did so before they ate shot up by 41 per cent.

The link between disgust and hand-washing intrigues OCD researchers, and several have suggested that obsessions and compulsions linked to fear of contamination by germs could be down to an excessive disgust response. Results from a few small studies support this link. Volunteers who report the most obsessive-compulsive thoughts and behaviours, for example, can be the most likely to experience more severe disgust when they see images of filthy toilets or gross injuries.

Of particular relevance is the mental impact: how a thought can bring on disgust, with physical consequences. Someone who has spent the night vomiting because they ate some dodgy shellfish need only think of a prawn sandwich the next day to set them off again. Charles Darwin, who was interested in the emotions − as well as the origins − of people and animals, noted this effect. He reported ‘how readily and instantly retching or actual vomiting is induced in some person by the mere idea of having partaken of any unusual food'. That sounds like thought-action fusion.

*   *   *

Perhaps the most famous case of contamination OCD relates to the bloodthirsty murder of a king and his guards, plotted and executed by a husband and wife. The man takes over as king, but after his wife handles the bloody murder weapon she is plagued by obsession. She feels compelled to wash her hands time and time again, yet she cannot scrub away the vision of the blood she sees there. It does not end well for either of them: she kills herself and he has his head cut off by a rival dressed as a tree. But then, that's what happens when you take career advice from strange women you meet on a Scottish moor.

Lady Macbeth, of Shakespeare's play and of course the woman mentioned above, might today be told she suffered from mental pollution: a sense of internal dirtiness that persists despite the absence of external dirt. Psychiatrists see mental pollution a lot with women who have suffered sexual abuse. No matter how often they shower and wash, the women still feel dirty, contaminated. In the last few years it has become clear that mental pollution can play an important role in OCD.

Andy suffered from severe OCD that was traced to mental pollution. A civil servant in London, Andy developed his condition in the 1990s after his wife left him for another man and Andy was pursued by the authorities for child maintenance payments. He became obsessed with thoughts of the brown envelopes they used to send their demands. He felt the envelopes could contaminate him. Andy would react to his feelings of contamination by washing his hands, up to eighty or ninety times a day. He had to sleep in gloves to protect his brittle skin.

Assuming that Andy was behaving in a similar way to OCD patients who fear physical contamination, germs from doorknobs for example, psychologists tried to help him with the same techniques they used for those patients. We'll come to exposure therapies in a later chapter, but here's a teaser: as part of the treatment, Andy would spend whole days covered in brown envelopes, from head to toe, in an attempt to make him less sensitive to them and their perceived physical threat.

But there was no perceived physical threat. It was not the physical envelopes that made Andy feel dirty, but the feelings associated with his thoughts of them. He did not even need to see one. He could conjure an image of the envelope in his mind that brought on such intense disgust that he would need to wash his hands. Just like Lady Macbeth, Andy's washing was futile, because the source of the sense of contamination was internal.

Mental contamination is closely tied to disgust. Imagine a stranger with bad breath and crumbs at the side of their mouth who grabs you unawares and presses their mouth against yours for a sloppy kiss. As you picture the scene, can you feel as your own mouth curls and your nose wrinkles in that familiar shape of disgust? Now, would you like a drink of water? In experiments with female students, after such an exercise a significant number said they wanted to rinse out their mouth or to wash their hands. Disgust caused by the thought of the dirty kiss – the thought alone – had made them feel dirty inside. They were mentally contaminated. Out, damned spot. Out.

*   *   *

If OCD is a product of shared evolutionary history, or the overreach of a natural capacity for ritual or disgust, then that might explain one of the most noticeable features of the disorder: consistency. It would mean that the condition does not crop up spontaneously in individuals, but rather as a shared biological response to some external or internal primer. We see this on the ground. Time and time again, different types of people with the same types of OCD report the same forms of obsessions and respond with almost identical rituals, even though they are separated by thousands of miles.

The nature of these shared obsessions and compulsions seems stable over time – case reports from centuries ago feature identical thoughts and behaviours to patients who report them now. And they are consistent across the world – identical forms of OCD have been found just about everywhere scientists have looked for them, from western Europe, the United States and Canada, to Latin America, the Middle East, China, India and Australia. In these cases, different cultures and experiences seem to make no difference.

A few years before I developed my OCD, Claire, a 10-year-old girl from Texas, came down with exactly the same obsession. When a schoolteacher told her class about the threat of Aids, she could not get thoughts of the disease out of her head. She would not eat in a restaurant in case someone had picked up food with bloody fingers, refused to kiss or hug anyone outside her immediate family, and had asked the school nurse about fears she would catch Aids from snot thrown in the classroom, a wet bus seat and a soiled book. When a boy in her class said: ‘Have sex with me. I hope you get Aids,' she found she had to repeat the phrase. Only if she then added a silent ‘just kidding' six times at the end of the sentence, she said, could she prevent harm to her six family members – herself, her mum, dad, brother, dog and fish. Claire developed other compulsive behaviour, and would feel urges to spit, hop and touch walls in sequences of six – all as a way to ward off the intrusive thoughts of HIV.

When Claire started to refuse to go to school because of her fears, her mother tried to help by explaining the sexual transmission of Aids. Claire responded by stopping the family dog from sleeping on her bed, because it was a boy. At this point, her parents took her for help. She was hospitalized but was helped to make a recovery. She will be in her thirties now.

Like Claire, I was lucky. Help for mental health in the UK is patchy, but after I saw my local doctor and told him my story it emerged that we were in the catchment area for a specialist outpatient OCD service based at a mental health unit at a hospital a few miles away. It was the same hospital where my daughter had been born. The doctor passed me along to them. This time, there would be no elastic bands. And this time, for my daughter's sake as much as mine, I was determined to make it work.

 

NINE

Man hands on misery to man

By the time my case worked its way through the health service to reach the specialist OCD unit, my obsessions about HIV had spread to the many different ways I thought I could pass the virus to my baby daughter, who by then was about eight months old. If I cut myself shaving, or in clumsy attempts at home improvement, I was compelled to wash my hands repeatedly before I touched her, in my mind to remove any risk that I could pass her contaminated blood. I was distraught. I had become a hand washer. My fingers were always chapped and dry. I told people it was because I had to clean and sterilize her milk bottles so often.

One night I showed her my electric toothbrush and woke with a start the next morning to intrusive thoughts that I had flicked my blood from its bristles into her eyes. I was compelled to check if I could have done. I locked myself in the bathroom, drew a face on the mirror with shaving foam and held the buzzing wet toothbrush at various distances to analyse where the water sprayed. It didn't help.

It wasn't just HIV by then. When I discovered that some of the old paint I had enthusiastically stripped and burned from the cupboard doors in our bedroom contained lead, I became convinced I had poisoned her. No matter how many times I cleaned the carpet, if I dropped one of her toys or her milk bottle I considered it contaminated. More blood tests – this time my wife and I for lead (both normal). My wife drew the line at tests on the baby, as my OCD wanted, because that required a needle to be stabbed into her young head. I even found a national lead paint hotline to call. On my third enquiry to them inside twenty-four hours, afraid they would recognize my voice and refer me to the answers they had offered previously, I convinced my wife to ask my questions for me.

I was concerned not just that I would pass HIV to my daughter, but also that I would act in a way that would make her more likely to develop obsessions and compulsions herself. On that score, I was right to worry. Studies since the 1930s have shown that OCD seems to run in families. Relatives of those with OCD are themselves more likely to show symptoms than the general population. So, here's another question, is OCD genetic? Do I carry it in my DNA?