Conquering Compulsion

By Dustin Cu

Entering a room full of people with Obsessive Compulsive Disorder (OCD) is an exercise in caution, knowing that a handshake here could cause as much anxiety as an earthquake.

For Adam, especially, the setting is shaky ground. Because of the severity of his symptoms, this nondescript conference room becomes a chamber of invisible germs and dirty flesh. Crammed with contaminated bodies, it might as well be the San Andreas Fault of OCD.

Doctor Jim Boyers retrieves one of Samuel's homemade cookies from the plate at the center of the table. "This is ERP," he announces.

As OCD therapist Jill Krafts explains, "ERP, or Exposure Response Prevention, is an extremely effective treatment that assigns 'homework' to OCD patients so they intentionally refrain from performing their compulsions."

Moreover, it forces the person to confront the very thing they fear.

Boyers hands the cookie to Krafts on his right. Krafts passes it to Jennifer, and so on around the table. Halfway around the room, the cookie lands in Adam's hands.

"Now Adam," instructs Boyers. "Take a bite."

Doctor Boyers and others like Adam attend a monthly support group at the Kaiser Permanente Hospital in Santa Clara for people suffering from OCD, a debilitating mental illness that affects one out of every 50 individuals in the United States.

Founded in 1997 by Jennifer See, the group has helped many make significant strides in overcoming OCD - including me.

Growing up in Arizona, I simply thought I was excessively neat. I organized things methodically, kept my room immaculately clean, alphabetized my basketball card collection several times a day and thought nothing of it. But these were not typical childhood fixations. These were obsessions.

Attending high school in the Philippines, I needed letters and numbers to be written so perfectly that each character had to resemble the last in size, shape and symmetry. When I wasn't satisfied with how something looked, I would erase or scribble it out and start over again.

By day's end, my fingers would be blistered and my math homework would look like a war zone of eraser residue and pencil lead casualties.

When I moved to California for college in 1999, the notion that I should start my life over clean was triggered in my mind. Clean, that is, in every sense of the word, down to the smallest particle of dust or droplet of water.

Living in an apartment off campus as a freshman, simple household tasks became arduous mental puzzles. I found myself poking around rooms, constantly straightening books and loose papers, repositioning tablecloths, placemats, seat covers, rugs and doormats.

I would stay up late into the night re-arranging plates and utensils in the dishwasher. I wasn't satisfied until all the plates and bowls faced the same direction, until there was a balance of spoons and forks in each compartment. Spoons had to be paired with forks, teaspoons with small forks, knives distributed evenly and all utensils had to rest at a certain angle, radiating outward.

I repeated this ritual with objects in cupboards and desks, on counters and shelves.

Clothes in my closet had to hang an equal distance apart on the rack, down to the nearest centimeter. I resorted to ending eye contact with my parents' closet, for fear that I might have to meticulously re-fold and re-hang every article of clothing inside.

I couldn't leave the house knowing that the shower curtain was not pulled back full length. I straightened towels, positioned the floor mat in line with the square floor tiles. I nursed a hatred of doors left half-open. I agonized over what direction the grains of the carpet were swept.

Eventually I would collapse on my bed in exhaustion, but when I got up I'd have to flatten out the bed sheet. OCD had so much control over me that I forfeited the right to have the form of my body imprinted on my bed.

People with OCD will latch onto a thought and never let go. They see unwashed hands, unknown diseases, uneven number combinations and unjustified page margins. When OCD inhabits your mind, you hear voices. Your head is thick with perfectionist urges that latch on to the deepest recesses of your sanity, convoluted formulas that you would never wish upon the most brilliant mathematicians.

I obsessed about anything and everything. Sticky residues. Stacks of canned goods. Basketball rosters. Combing my hair. The size of a computer file, the date and time it was created, last modified, last accessed.

A computer's hard drive can become the source of an infinite number of organizational systems, each as incomplete and unsatisfying as the next, according to Amy Wilensky, author of Passing For Normal.

I performed counting rituals in my head when I washed my hands, balancing strokes right to left, left to right, finger to finger and wrist to wrist. For more than a year I covered the clock in my car because "bad" number combinations made me so uncomfortable I couldn't drive. The numbers three and seven had become the scourge of my existence.

Writing essays by hand, I was barely able to summon the energy to stick periods onto the ends of sentences. I wielded the pink end of my pencil with such urgency that often I ended up boring a hole through the paper. At that point in my life, my confidence was indeed paper-thin.

It reached a point where I felt completely paralyzed by these ritualistic behaviors and painful roadblocks in my mind. I simply wanted these thoughts to stop.

In the spring of my freshman year I finally confronted the disease. The therapist I had been seeing regularly recommended the support group at Kaiser Santa Clara, which I began attending every month. It was the best advice I ever received.

Strange as it sounds, it is comforting to know that other people share the same absurd thoughts that I have.

Familiar faces filter into the conference room and take their places around the oval table. As always, I am the youngest of the group. Many here have been fighting OCD for decades, but many have just begun the uphill climb. This makes for some interesting group dynamics.

Veterans will engage in conversation, throwing around the names of treatments, therapists and medications as if they were the latest Hollywood blockbusters. Gary is the group's resident talker, a walking OCD resource library. Samuel, whose teenage son is both manic-depressive and obsessive-compulsive, often brings cookies to the meeting.

Newcomers, on the other hand, will sit guarded, observant and quiet.

OCD rarely manifests itself out in the open. It remains a hidden epidemic because its sufferers are so adept at concealing their symptoms. After all, Jennifer explains, people with OCD are some of the best actors around.

But Jennifer, in her early 30s, has nothing to hide. She is the picture of poise - often buoyant and upbeat, but serious and understanding when need be. She sits at the head of the table and begins each meeting with a summary of her own struggles.

The symptoms began when she was a student at San Jose State University, amid a flurry of news stories about Lyme disease. "Somehow it just clicked in my head that, 'My gosh, I had Lyme disease,'" Jennifer said. "I couldn't shake the thought."

For months, Jennifer believed she had Lyme disease. She researched endlessly to prove she had it.

"In part, I knew that I didn't have Lyme disease," she said. "I was kind of ashamed that I kept thinking about it."

She never told her doctor about her very specific concern, and instead would make up different excuses for her frequent medical visits. She spent days waiting for the diagnosis, convinced the doctor didn't get it right the last time.

"It got to the point where 24 hours a day, that's what I thought about," she says.

OCD also mutates, transferring obsessions to new places, situations and symptoms. So Jennifer began obsessing about other diseases: rabies, cancer and leukemia.

Driving in heavy fog one morning, Jennifer thought she had struck some kids on the side of the road. "I knew I didn't, because they were all on the sidewalk," she said. "But somehow it clicked. 'What if? You know, it's foggy. What if I hit them? What if I didn't know? What if they got hurt?' And so for the rest of the day I thought about it. That was the core of the issue. I was afraid that somehow my actions hurt somebody."

This was how the driving issues began. Jennifer would be late for work because she spent hours on the road, always anxious that she had hit someone, always turning back to check her tracks. It took her three hours to get to places that should've taken only 15 minutes.

Soon after graduating from college she came across an episode of Donahue, a television talk show, highlighting OCD. "They were describing all the symptoms," Jennifer recalls. "Every person on that panel, I could pick one thing out that I had done.

She started the group six years ago, after discovering that there was little support for OCD sufferers in the Santa Clara area.

"I think it helps me the most," she said about the group. "It's giving me the chance to let people know there's hope out there, there's help out there and you can get better. You don't have to drop everything you like to do because of OCD. You can have OCD and live your life."

But getting there is the hardest part. It is difficult for Adam, 45, to come to the group because he struggles with contamination issues - the copy machine at work is a daily problem since it harbors so much human traffic.

This concern with germs follows Adam everywhere. If he comes into contact with someone he deems "dirty," he must follow a specific regimen to become clean again. He not only goes home to take a shower, but also washes the car he drove home in.

"It's almost like you're punishing yourself," Adam said.

Ironically, Adam goes to great lengths to keep himself clean, but his house is covered in thick layers of dust. He admits there is probably enough mold on his windows to poison him. It's even possible his scalding hot showers actually cause the mold.

It takes amazing willpower for Adam to be here. Being in the same room in such close proximity with this many people heightens his anxiety. His eyebrow movements become more rapid. His twitching tics increase. Adam is always first out the door.

At least Adam makes it to the meetings. I remember seeing Nadine at the support group several months ago, but she hasn't been back since.

Nadine, 30, lives alone in her apartment in San Jose, where she keeps her own washer and dryer because the common laundry facilities are too "dirty." She moved here from India two and a half years ago, where she studied at one of the country's best universities. Yet, she insists that things become dirty when they are touched by anyone.

In fact, Nadine is the only person who can make something truly "clean," so each day she spends an hour showering and two hours rinsing clothes. Because of these washing rituals, she has difficulty leaving home and is chronically late. Recently she was laid off from her job as a mechanical engineer.

Indeed, the worst weapon of OCD is its ability to trap yourself within your own mind.

Unlocking the brain is like separating overcooked spaghetti strands, impossible to untangle without inflicting damage. Although medication can help, the preferred treatment is Exposure Response Prevention, or ERP.

ERP gives patients a two-handed shove in the back, pushing them directly into their own dark room of anxiety. The more extreme forms of this treatment range from dumping trash on the patient's head to spraying Raid on everything in the room.

Although the disorder is caused by a chemical imbalance in the brain, explains Krafts, ERP can actually change your brain chemistry.

After more than a year of therapy, I was ready to live on my own. I began taking small steps toward getting better, and I stopped seeing my therapist. The support group became my sole lifeline.

I was able to decrease the rituals by applying behavioral techniques to my daily routine. I forced myself to delay the compulsions - however painful - until the anxiety dissipated. I have learned to repress many symptoms, but OCD is still present in my life.

It's still difficult to finish activities without getting to a certain number, without achieving some self-defined quota of time or productivity. Even the process of writing, the very thing I am most passionate about, has been infiltrated by OCD.

I obsess about the number of letters in a word. Odd numbers remain the ultimate bane. I fret over where the last line of a paragraph ends. I cannot sleep knowing that I may have hit the space bar one too many times after this period.

Many, like Jason, 29, have it much worse. In fact, he says, "it has been hell." The Saratoga real estate broker can spend up to eight hours checking his body for signs of cancer. Last year he was so fixated with a mole on his face that it drove him to drastic measures. "I kept staring at it, measuring it, reading books on it," he says. "Finally I just cut if off myself.

"No matter how much I know about it and know that it's not real, it still can control my life," Jason says. "I've waked to so many years with this. I quit drinking - that was hard, but that was simple compared to this."

OCD Support Group meeting: Saturday, February 2, 2003

Doctor Boyers has just asked Adam to take a bite of a cookie "contaminated" by every hand in the room.

Adam smiles. There's no way he is letting that cookie come near his mouth.

The cookie resumes its route. Gary touches it to his nose. Boyers goes a step further. He rubs the cookie against the material near the armpit area of his shirt. Then he asks everyone to take a bite.

Krafts does. Jennifer doesn't, claiming she has a cold. As the cookie speeds toward me, I think of the people's hands, the things the people's hands have touched, the stuff on the things that the people's hands touched, where the stuff on the things that the people's hands touched came from. And the armpit thing -this man is crazy. I ask Boyers if I have to do it.

"Nobody here has to do anything," he replies.

The next time the cookie comes around, I break off a piece and take a bite.