Free The Man Who Couldn’t Stop by David Adam Page A

between, are not patients. To suggest that we do more to identify and treat such individuals implies that we know better than they whether and when they need our help.
    Who needs help? I did, but I didn’t accept that I did, at least at first. One problem with OCD is that this ‘at first’ stage can last for years. That’s down to a mental paradox. On the one hand, the thoughts and fears of OCD blended so seamlessly with the rest of my cognition, they felt so embedded and so real that it was hard to believe they could be taken away. On the other hand, I knew the thoughts were silly. And just like almost everybody, I had other types of silly thoughts too. I felt the urge to jump from a high place. I had random ideas that I had written the wrong name on a birthday card the moment I sealed it inside the envelope. I checked the back door was locked even though I just turned the key. And these intrusive thoughts went away. They went away by themselves. So I thought my thoughts of HIV would also go away by themselves.
    I knew that I couldn’t catch Aids from someone else using my toothbrush, or from dried blood on the ice rink where someone had burst their nose, or from blood that might be contained in water dripping from an upstairs window that landed in my eye when I looked up. I knew that if I had sat on a drug user’s syringe I would have felt it. I knew that my mum’s towels were safe, even though she had to have a blood transfusion one Christmas. And so I thought that one morning, hopefully tomorrow morning, I would wake up and leave behind the silly thoughts that made me worried about all of those things. Unfortunately, that’s not how OCD works. My intrusive thoughts did go away, but there was a catch. One went away just as soon as another came along to take its place.
    It was the US psychologist William James in 1892 who first described thoughts as a ‘stream of consciousness’. The term was subsequently popularized by a writing style in which undirected words seem to flow from an author’s head onto the page – Ulysses by James Joyce is perhaps the best-known example. Like all streams, this mental flow is uneven – there are fast and slow sections, eddies and currents, pools and falls. Some thoughts relate to current tasks, or those we have just finished or are about to start. Some are triggered by other thoughts or by actions, or as a clear response to external events. Intrusive and obsessive thoughts are different. They seem to bob up from nowhere.
    I was a serial monogamist when it came to OCD. My stream of consciousness had a taut net strung across it, a net just big enough to trap one misshapen irrational thought at a time. The only way to free a trapped thought was for another to knock it out, send it on its way, and for it to settle there instead. Some intrusive thoughts would remain for days or weeks, others would last for just a few minutes. But the net was always full. And the content of the net, the thought that was in residence at the time, was always on my mind.
    *   *   *
    Not everybody experiences OCD in the same way. For some people with OCD the mental hijack of their attention is the only apparent symptom of the disorder. They don’t carry out overt compulsions. They don’t feel the need to convert their mental anguish into physical form. They say they suffer from a form of OCD called pure-O.
    Most of these people, scientists think, do still carry out compulsions – but they are mental compulsions. They might try to ‘undo’ the impact of an intrusive thought by deliberately thinking of something else to neutralize it. Or they might start to predict the kind of situations that are likely to trigger the unwanted obsessive thoughts, and then seek to avoid them. Both of those mental routines are compulsions. When someone with OCD uses them to suppress or push away the thought, they reinforce it as surely as if they had