Controlled by Thoughts
David Adam’s Man Who Couldn’t Stop: OCD and the True Story of a Life Lost in Thought provides a sweeping analysis of obsessive-compulsive disorder by not only exploring a multitude of cases, but also critiquing the way it is treated and perceived by the media. Speaking from experience, Adam describes the disorder from a first-person point of view, as well as describes certain particular cases of OCD in their many shapes, forms, and intensities. Though they both set out to instruct the general public on the disorder, the novel and the class present different perspectives. The novel gives a more detailed analysis of the range of obsessions and compulsions that can develop than the class did, and dealt with more specific case studies, which create a more in-depth look into the reality of the disorder. Adam also intended his accurate written representation of OCD to chip away at the dramatized, stereotyped version depicted in the media. On the other hand, the lectures focused on teaching the cognitive-behavioral model of OCD and the processes that contribute to the cycle of thoughts becoming obsessions. Through group meetings, the book club members were able to draw connections between the book and the class and unfold the many layers of OCD.
First of all, the novel and lectures used different approaches to introduce their respective readers and students to OCD. The novel jumped between recounting the story of a girl named Bira from Addis Ababa with a terrible case of OCD, to examples of Adam himself experiencing OCD symptoms, to metaphors describing the nature of OCD, to the way it is conceptualized by Western psychiatrists. The lectures, however, methodically started by discussing the history of the disorder. OCD was thought of as an extension of melancholia for centuries before intrusive thoughts were recognized. Then the lectures continued by detailing the DSM-5 criteria and the types of behaviors seen in individuals with OCD, such as the kinds of intrusive thoughts, obsessions, rituals, and compulsions that plague those affected. The lectures were clearly divided into subsections whereas the novel was flighty, leaving certain ideas and coming back to them later, discussing many different topics and ideas at once. The book was fun to read and always interesting. This difference illustrates the disparity in the audiences both the class and the novel had, and the objectives each had. The novel was interesting and compelling as a work of literature rather than a textbook. The lectures were expected to teach college students about OCD and the way it works, as well as its history. As a result of being exposed to both sides, the group members had discussions about the interesting stories featured in the book, compared to the technicalities of OCD taught in the lecture.
Adam set out to explain the process by which OCD develops through his own personal experience, which can be traced to the cognitive-behavioral model highlighted in class. He introduces readers to the disorder by recounting the conception of his own OCD. While in college, he spent a night with a girl, and lied to a friend the next day that they had had sex without using a condom. The friend mentioned that people get AIDS by having unprotected sex, which ended up scaring Adam. This initial fear, that he could somehow acquire AIDS, was the driving force behind his unwanted thoughts. The words “You could have AIDS” reverberated in his mind, and he would feel scared. Could he have AIDS? He thought about why he was having the thought, exemplifying the appraisal and interpretation section of the cognitive-behavioral model. Then, he would say to himself, “Don’t be daft.” Although he knew rationally that it would be impossible to have contracted AIDS because he and the girl had not had sexual intercourse, he started experiencing more of these unwanted thoughts. Adam repeating the words “don’t be daft” is an example of verbal neutralization. It resulted in heightened anxiety, as well as the intrusive thought – “you could have AIDS” – coming back over and over. “As I tried to brush away the thought, the snowflake, it squirmed from my mental grasp and settled,” Adam said, describing his catastrophic reaction to the intrusive thought. “The blizzard that followed blew the snow into every corner of my mind, and laid down a blanket that muffled every surface” (Adam, Location 221). His desperation to cover up the thought, ignore it, remind himself that he could not possibly have AIDS, only made the thought come back stronger. His obsession with AIDS and cleanliness ensued, as did his compulsions. He began checking for blood on items such as doorknobs, public bathrooms, and objects strangers may have touched. The compulsions and obsession began to take over his life.
Essential to the explanation of OCD in the novel and the class is the natural way intrusive thoughts present themselves. Everyone has intrusive thoughts; what separates people with OCD from people without OCD is the interpretation of these thoughts. People who do not have OCD experience the exact same types of intrusive thoughts as people with OCD – thoughts of violence, self-harm, infection, disease, and sexual acts labeled as abnormal to name a few – but when they experience the thoughts, they do not react strongly. They let the thoughts float away. When people with OCD experience the same thoughts, however, they wonder why this thought popped into their head, they wonder if having the particular thought makes them a bad person, and they try to get rid of it by ignoring it or neutralizing it. Every time a person attempts to neutralize their intrusive thoughts, their anxiety is temporarily reduced, but then shoots up when the thoughts inevitably come back. The subsequent fluctuating anxiety feeds into the obsession, making the thoughts come back more frequently and making the appraisal and interpretation more desperate. Everyone has intrusive thoughts, and might notice them from time to time, but typically do not mull over them and spend time interpreting them. The start of what could become life-altering OCD is a natural way of thinking that everyone experiences.
Adam goes on to describe the wide range of the ways OCD can manifest, from the precursors to the symptoms. The precursors to OCD can be evolutionary, biological, genetic, but also influenced by the environment; sometimes a traumatic event can lead to OCD. The group discussed the way OCD is conceived and developed; why do some people simply react more strongly to intrusive thoughts than others? We knew such personality traits as perfectionism and feelings of responsibility are emotional vulnerabilities for OCD. If someone is a perfectionist, they would probably be more likely to find certain thoughts to be intrusive. Perfectionism serves as a predisposition for many anxiety disorders, such as eating disorders and hoarding. Additionally, perhaps someone with a responsible personality is more likely to not want to get sick because it would mean giving up commitments or not living up to their usual standards. Fearing sickness, in turn, may explain obsessions and compulsions surrounding cleanliness. On another note regarding possible causes of OCD, the same kinds of traumatic events may incite different reactions in the form of mental illness. The same traumatic event could happen to someone, but their personality traits help determine the way they will react to them. Based on the lectures, the people who develop PTSD tend to have preexisting anxiety and pessimistic worldviews. The people who develop OCD tend to be perfectionistic and responsible instead. The actual kinds of obsessions and compulsions seem to be shaped by the person’s environment in addition to their personality; specifically, religion can influence the kinds of thoughts a person would label as intrusive. For example, thoughts of sexual acts may make someone who is religious feel like they are having blasphemous, evil thoughts, when someone who is not religious may think about sex in a completely different context, without feelings of shame or embarrassment. In both the book and the lectures, it is made clear that religion cannot cause OCD, but can rather dictate which kinds of thoughts become intrusive in someone who was prone to developing it. The complicated interactions between a person and the world around them can result in different patterns of mental illness.
Among the treatments for OCD are medicine, psychosurgery, CBT or cognitive behavioral therapy which involves exposure to what causes obsessions and compulsions, and group therapy sessions. Group therapy sessions are sometimes effective because they allow people to relate to one another, finding solace in the knowledge that they are not alone and that other people understand how they feel. However, Adam notes that group therapy may not have the effect it should in treating patients because searching for validating comments from the other members of the group can become an obsession itself and exacerbate the existing condition. Adam cites learning how the disorder works, breaking down the processes of his brain, and understanding why the thoughts kept coming back, as helping him overcome his disorder. He praises as well as critiques exposure therapy. He says that what was most effective was exposing himself to his fear of AIDS by resisting the checking behaviors of looking at his hands or doorknobs for blood. But he was told to smear his daughter with his own blood, which he never did, and still was able to overcome his OCD. The lectures explain that exposure and response prevention are highly effective, but do not give individual accounts of how the worked. Group therapy is not mentioned, perhaps because it is not as effective. Adam’s written personal experience brought to light how different forms of therapy can affect people with OCD.
The class followed closely the cognitive-behavioral model of OCD, whereas Man Who Couldn’t Stop primarily followed the author’s own experience with the disorder. The book also provides a critique on therapeutic tactics, while the class focused on the therapies that have been shown to be the most effective. The novel had the objective of debunking certain myths regarding OCD to hopefully start to derail the false representation of the disorder in the media. The course, however, had the objective of teaching college students what OCD is and how it works. The content of both the book and the class ended up being altered by their respective audiences. Ultimately, learning about OCD from the book in addition to the lectures, as opposed to simply one or the other, gave a much more in-depth understanding of the way this disorder works.
