Free The Man Who Couldn’t Stop by David Adam

generation comprises one of the best so-called cohort studies in the world – long-running surveys of the health of a group of people, how it changes and how it is influenced. Cohort studies are pretty common, but what sets the Dunedin work apart is the effort the study organizers make to keep it going. On assessment day, which comes every few years, they bring participants back to Dunedin from wherever in the world they live. Some 96 per cent of all living participants were included in the round of check-ups when they were aged 32. That’s unprecedented for such a study, which typically sees at least a third of the original subjects drop out by that stage.
    The Dunedin data set is valuable to scientists interested in the real-time study of human health and development. Another of its attractions is that it probes the mental as well as physical health of its volunteers, with a psychiatric assessment part of its battery of tests. The Dunedin data set has been used, for example, to assess the role that teenage use of cannabis could have in people who go on to develop psychosis. And it’s been used to probe the levels of OCD in people who, according to the official cut-off line set by psychiatrists, don’t have OCD at all.
    When scientists looked at the results for two of these Dunedin assessments – performed when the participants were aged 26 and 32 – they found that up to a quarter of the cohort had reported some form of recurring obsessive thought or compulsive behaviour in the previous twelve months. And when the scientists published these findings in 2009, they raised an argument in the academic community. This wasn’t because of the results, which were in line with those from other studies. A 2010 survey of almost three thousand people across Belgium, France, Italy, the Netherlands, Spain and Germany, for instance, found that 13 per cent of the subjects admitted to a period of two weeks or longer when they experienced unpleasant recurring thoughts or felt compelled to perform repeated actions at some point in their life. And a similar exercise in the United States reported the same year that 28 per cent of Americans had experienced such a two-week spell.
    No, the controversy came because the scientists said the results of the Dunedin psychiatric assessments held some important implications for society. In the official write-up of the study’s findings, the researchers suggested that doctors screen the ‘normal’ population to identify – and treat – these subclinical obsessive and compulsive symptoms. This might lower the risk of some people going on to develop ‘full-blown’ OCD, and other mental health problems, they said, which would reduce distress and costs in the long run. They concluded:
    Cost-effectiveness analyses will be required to decide whether these cases should be treated, but such calculations should take into account that treatment of mild cases might prevent a substantial proportion of future serious cases.
    Not so fast, said Murray Stein, a psychiatrist at the University of California San Diego. In an editorial published in the same issue of the American Journal of Psychiatry as the Dunedin study’s results, Stein cautioned against any assumption that people with symptoms of OCD need help if they have not asked for it. ‘We must consider,’ he said, ‘the very real possibility that the reason so many people with obsessive-compulsive symptoms fail to get treatment is that they manage quite well.’ He continued:
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    As mental health professionals, we should do everything we can to promote awareness about and accessibility to mental health interventions. As clinicians we have an obligation to help reduce the suffering and improve the functioning of the patients who come to us for help. But, lest we forget, most people with obsessive-compulsive symptoms in the community, whether diagnosable or subthreshold or anywhere in