how do you know? what OCD and eating disorders have in common
The more I learn about mental disorders, the more I’m struck by the similarities between them. If you dig deep enough, it seems that we are all broken in the same way.
Ever since I started to study psychology over 10 years ago, OCD has been my “favourite” disorder. You know… as much as you can actually have a favourite mental illness.
I don’t know why. Maybe certain rituals, certain compulsions felt familiar. The way I always had to top up my tea, when someone gave me a cup not quite full. The liquid had to be about half an inch from the brim. Or the way I had special pens that I had to use in lectures. Pens that were just right. And it bugged me to no end to forget those at home. I couldn’t just borrow a pen. Well, I could. But the notes never quite looked right. The lecture notes I took on scrap paper, because I always meant to re-write them “perfectly” after.
Yet as I re-read “The Boy Who Couldn’t Stop Washing”, by Judith Rapoport, a book I bought while still in high school, I marvel at the quote: “In one way or another, every patient with OCD wants to know how to know”.
In OCD, how do I know if I killed someone? Or rather, how can I be sure that I didn’t? How do I know when I’m clean enough? How do I know when I can stop checking whether the stove is off? How? How?
Family members and loved ones are often affected as well. Unless you are the master of disguise, of course. Rapoport describes a mother who, not seeing any other alternative, joined in her son’s rituals. “She knew they were crazy. But it was hard for her to see him so miserable if his rituals were not carried out. So she cleaned everything he might touch with rubbing alcohol. She helped him scour his room over and over again. She kept people out of the house to prevent ‘contamination’ from the street.”
The movie Matchstick Men (2003) with Nicholas Cage portrays an OCD panic attack quite well. I’ve shown clips from this movie in class many times, and some students laugh. I get the chills. The sheer horror that crumbs on the carpet bring.
In eating disorders, we also want to know how to know. How do I know I’m not fat? How do I know I’m thin enough? How do I know when to stop eating? How do I know when it’s ok to eat? How do I know this cookie will not kill me? How do I know I’m ok? How do I know I’m enough? How? How?
“Do these people know they have OCD?”, one student asks in introductory psychology lecture, as I talk about the disorder. What he means to ask is: “Do they know it’s freaking unreasonable and crazy to wash your hands 50, 100, 200 times a day?”.
Yes, they do. Every individual with OCD, save for really young children, knows that the compulsions are not “reasonable”. It’s not “reasonable” to spend two hours showering, or to have to enter a doorway “just so”, or to clean the house from top to bottom just to start over when you finish. But reason does not even enter the equation. You have to.
You have to. Or else.
Just like someone with bulimia knows perfectly well that it’s “unreasonable” to consume three pounds of blueberries, a jar of pickles and a pot of chicken soup. And then you have to get rid of it. You have to.
You are stuck.
Charles, a 14-year old boy with OCD, is perfectly pleasant at first, until the doctor asks him to undergo an EEG, a brain test that involves putting some electrodes on his scalp, using a special sticky paste. Suddenly, OCD has Charles in its firm grasp. “Stickiness is terrible”, he shouts. He is a ritual washer, and sticky things are the worst. In fact, he would rather die than touch honey.
Stickiness IS terrible. It keeps you… stuck.
Jean-Paul Sartre, a French philosopher and novelist, writes “Stickiness is halfway between solid and liquid. It is soft, yielding, and a trap. It clings like a leech and attacks the boundary between oneself and it.”
“Columns of stickiness falling from my hand, he says, “suggest my own substance is flowing into a pool of stickiness”.
Perhaps ironically, one of Sartre’s better known novels “Nausea” is about a historian who becomes convinced that inanimate objects in his life encroach on his ability to define himself, evoking a sense of, you guessed it, nausea.
Some off switch, some lever, some mechanism is broken. Like a thermostat, which in absence of appropriate instructions, continues to heat the room. Higher and higher. Hotter and hotter.
Been to hell and back (still visit sometimes),