News OCD: living with a monster About 1 in 200 adults have OCD. And it seems that the condition is as old as humanity. But what is it? And how can we treat it? Alan Barker attended a fascinating conversation between Uta Frith and David Adam – and had his own ignorance challenged. David Adam is the author of The Man Who Couldn’t Stop, in which he describes his experience of OCD and the science that helps us understand it. As we joined his conversation with Uta Frith at this year’s British Science Festival, I honestly expected to see him spend an hour arranging the glasses on the table between them. Such was my appalling ignorance. I left, 60 minutes later, enlightened and chastened. Uta – a developmental psychologist working at the Institute of Cognitive Neuroscience at University College London – opened by asking us to develop our understanding of OCD beyond a kind of cosy, domestic concern with tidiness, towards something deeper and far darker. A relatively mild form of the condition might be typified by what the French call folie du doute. Did you turn off the gas? Did you lock the car? Now go beyond this morbid scrupulousness about minutiae. You’re in the car and the thought occurs to you: I could, at this moment, deliberately drive head-on into that oncoming truck. You stand on a cliff edge and think: I could throw myself off, right now. You hold your new-born child and think: I could throw this baby down the stairs. We all have these thoughts. Most of us dismiss them with a shudder. But sometimes – particularly if they relate to the most precious things in our lives – they stick, recur, and refuse to disappear. OCD exploits a magical connection between thought and action. “You can’t,” said Adam, “out-think a thought”; the only respite comes from doing something. But, because the thought of action can be as powerful as the act itself, doing something can never dispel the thought. Therapists call this thought-action fusion. And it seems to be as old as humanity: the last three of the Ten Commandments regard coveting – thinking about doing something – as a sin no less dreadful than committing murder or adultery. These bad thoughts, if they become uncontrolled, can threaten our effectiveness, our wellbeing, and our very sense of identity. Notice the idea that thoughts come to us. In the old days, we might have defined them as invasive demons, and the appropriate treatment might have been exorcism. By the turn of the 20th century, we had – maybe – moved beyond ideas of evil spirits; but, 100 years later, we still have no authoritative alternative treatment. Adam explicitly blamed Freud: just as the French were about to crack the problem, he suggests, Freud claimed that it was “all down to childhood masturbation – which threw the whole thing off the rails.” Freud could assert the power of his ideas only by discrediting the ideas of others – and the development of psychology was held up for half a century. OCD, in Adam’s words, is a pathology of thought; but only in the 1980s did we begin to say: “Let’s ask people what they think.” As a result – and because of the continuing widespread misunderstanding and misinformation surrounding OCD – people with the condition often fail to recognise it, and so fail to come forward for treatment. And the treatments themselves vary, from the pharmacological – prescription drugs that seem to affect the neurotransmitters implicated in OCD – to the behavioural – altering or expunging the rituals triggered by the thoughts, to reduce the all-consuming anxiety. OCD, as Uta Frith explained, seems to prey on our search for a non-existent certainty; the treatments offered by science seem to offer only proximate solutions. Adam insists that OCD is a condition of the mind. Does the cure, then, lie in the brain? After all, as he said, “the brain does the mind;” and Uta expressed her fervent hope that, one day, we might resolve the question of how, exactly, it does so. Adam, meanwhile, seemed to imply that the way forward might be to challenge the primacy of the mind in our sense of identity. He pointed out that Descartes’ famous quote – “I think, therefore I am” – is incomplete. In full, it reads: “I doubt; therefore I think; therefore I am.” We think because we doubt – and OCD, says Adam, is all about endless, paralysing, overwhelming doubt. Maybe the lesson of OCD is that we should not allow the mind to tyrannise our experience. But ‘should’ is a cruel word, especially if you are living with this monster. Perhaps, suggests Adam, by simply looking at OCD more clearly, we can help it to become, if not less obsessive or compulsive, at least less of a disorder. Alan Barker, Swansea British Science Festival, September 2016. Alan Barker is a writer and training consultant specialising in communication skills. He is Managing Director of Kairos Training Limited.