David Adam has written a wonderful book about his decades-long struggle with Obsessive Compulsive Disorder. Adam, a journalist for several years with The Guardian and who now writes for Nature, has written both a personal account of his OCD and a factual and historical account of this debilitating mental condition.
For him the OCD centred around an irrational fear of getting HIV/ Aids. In practice this meant that every possible public surface was a source of fear. However much his rational mind told him that he couldn’t get HIV from a door handle, the irrational fears won out (with crippling consequences).
The Man Who Couldn’t Stop (Picador: 2014) is open, engaging, punchy as well as very interesting. There were moments when I could have done with less history (e.g. on lobotomy and leucotomy) and more personal narrative. But given that this must have been a very difficult book to write, Adam has done incredibly well. The parts I found most interesting were those in which he described the genesis of his own OCD, the description of his treatments (both drug and CBT), as well as the discussions about neuroscience and the difficulties of categorisation. As with all the best Science writers, Adam manages to be interesting, knowledgeable and very accessible.
I do have a few gripes though, and perhaps the first one is his dismissal of Freud and psychodynamic therapy. He gives a shortish account of Freud’s famous OCD case (the “Rat Man”) and then laughs off Freud’s emphasis on the psychosexual origins of the Rat Man’s obsessions and compulsions. Psychodynamic psychotherapy has moved a long way from Freud’s original ideas and the emphasis these days tends to be far more on the early bond and relationship with the mother (or primary caregiver) than on any sexual rivalry with the father. Interestingly, while CBT is the psychotherapeutic treatment of choice (together with SSRIs) for OCD, the current research on the importance of primary attachments means that psychodynamic therapy is still incredibly relevant here as well.
Adam provides a glimpse of possibilities (admittedly quite dismissively) in his final chapter:
This should be … the point … where it all comes together. Having discussed the possible causes of OCD – the genetic, family, social, Freudian, environmental, infectious, psychological, medical, traumatic and just plain unfortunate pressures that might contribute – I should reach a triumphant and emotional conclusion. … It was my parents what did it or my childhood fear of dogs … [the] betrayal by the boy who I thought was my friend … [that] my mother had a stroke and couldn’t hold me as a baby …
I couldn’t help noticing that this was the only mention of his mother in the book. Similarly, his wife is only mentioned in the acknowledgements. Surely Adam’s OCD must have been incredibly difficult for this relationship as well? But I can also well understand the reluctance to go there. It’s one thing admitting that you have a mental illness without dragging your nearest and dearest into the mix as well.
Jenny Turner, reviewing in the Guardian, writes:
His fear … seems to be some sort of death-fear, associated with blood and sex and other usual suspects, triggered perhaps by his misfortune in having reached sexual maturity just as an emerging disease became the focus for a massive moral panic. So Adam’s Aids fear, too, makes most sense when looked at sensitively and symbolically, as a story.
It’s easy, I suppose, to say that we would like Adam to be able to look at the symbolic side of his crippling fear. What he has done is extraordinary enough.