CAN’T STOP, WON’T STOP

The Washington Post Sunday - - OUTLOOK - RE­VIEW BY MAR­I­ANNE SZEGEDY-MASZAK Mar­i­anne Szegedy-Maszak is a se­nior ed­i­tor in the Wash­ing­ton bureau of Mother Jones and the author of “I Kiss Your Hands Many Times: Hearts, Souls, and Wars in Hun­gary.”

Cat hoard­ing and other com­pul­sions.

Apsy­chol­o­gist friend once de­scribed a se­ries of ques­tions one of her pro­fes­sors had posed to her ab­nor­mal-psy­chol­ogy class. “A woman has one cat,” she be­gan. “Is that un­usual?” Of course not, was the over­whelm­ing con­sen­sus. “Okay, what about two cats?” she con­tin­ued. “Would that raise flags about her men­tal state?” Again the con­sen­sus was no. “Three cats?” she asked. A few stu­dents ex­pressed a lit­tle dis­com­fort with the three­cat thresh­old. “How about four? Or six? Or 10?” she con­tin­ued, with each ad­di­tional fe­line adding a new layer of psy­chopathol­ogy. For some, three cats sug­gested that the woman might have at­tach­ment is­sues. Could the 10-cat owner be a hoarder? (One can only imag­ine how the house must look and smell.) The cat es­ca­la­tion con­cluded with this query: “How many cats in­di­cate crazy?”

Just what kind of crazy 10 cats il­lus­trate might be an­swered in Sharon Be­g­ley’s com­pelling new book, “Just. Can’t. Stop.: An In­ves­ti­ga­tion of Com­pul­sions.” This in­ves­ti­ga­tion by the STAT writer and for­mer sci­ence colum­nist for Newsweek and the Wall Street Jour­nal ex­plores the mean­ing and the neu­ro­science of some of the hardy peren­ni­als of com­pul­sion — ob­ses­sive-com­pul­sive dis­or­der, for in­stance, and hoard­ing — but also those that might be less de­bil­i­tat­ing. Why would the self­less act of do­nat­ing a kid­ney be con­sid­ered a com­pul­sion to do good? It would when the donor feels “ir­re­sistibly, of­ten in­ex­pli­ca­bly driven to en­gage in” this level of self­less­ness, es­pe­cially given that this act is, per­force, only pos­si­ble once. Is la­bel­ing so much of what we do as “com­pul­sions” just an­other way to pathol­o­gize the full spec­trum of human be­hav­ior?

The an­swer is clearly no. But one of the strengths of this book is Be­g­ley’s rig­or­ous clar­ity about her sub­ject mat­ter. She ad­mits that she does not want to seem like the “ham­mer-wielder to whom ev­ery­thing looks like a nail,” but the breadth of her knowl­edge and jour­nal­is­tic rigor pre­vents such ex­cess. She draws a bright line be­tween our col­lec­tive and nearly univer­sal smart­phone-scan­ning, com­puter-de­pen­dent ac­tions and those that are ev­i­dence of a deeper dys­func­tion. “We de­scribe as ‘com­pul­sive’ some­one who reads, tweets, steals, cleans, watches birds, lies, blogs, shops, checks Face­book, posts to In­sta­gram, eats, or Snapchats not only fre­quently but with the ur­gency of some­one not fully in con­trol of his be­hav­ior . . . . Our com­pul­sions arise from a mor­tal ache that we will go to what seem the cra­zi­est ex­tremes to soothe.” Do­nat­ing a kid­ney is an ex­traor­di­nar­ily self­less gesture, and yet, Be­g­ley notes, for some the propul­sion to do this is not sim­ple gen­eros­ity but the need to make bear­able a nearly un­bear­able mor­tal ache that is cre­ated by anx­i­ety — the uni­fy­ing emo­tion shared by all com­pul­sions and one that seems to de­fine the 21st cen­tury.

It is hardly sur­pris­ing that dur­ing a time when anx­i­ety is far more com­mon than de­pres­sion — the Na­tional In­sti­tute of Men­tal Health has de­ter­mined that “in any twelve-month pe­riod 18.1 per­cent of U.S. adults suf­fer from anx­i­ety in­tense enough to be con­sid­ered a dis­or­der” — wild and varied com­pul­sions should de­fine and up­end so many lives. In her vast re­port­ing, Be­g­ley in­tro­duces us to a com­pul­sive shop­per, So­phie, whose at­tempt to purge the moun­tains of stuff in her house was cut short by a call from her abu­sive fa­ther — af­ter which she bought eight vac­uum clean­ers. We meet a com­pul­sive gamer, Ryan Van Cleave, who changed his name to that of a char­ac­ter in World of War­craft, a video game he played up to 80 hours a week, more than 12 hours a day, at the ob­vi­ous ex­pense of his family and pro­fes­sional life. Only a failed sui­cide at­tempt loos­ened the grip of his gam­ing com­pul­sion. And there’s Tom Somyak, whose worry about his door be­ing un­locked shaped his wak­ing hours and was only a pre­cur­sor to his fa­nat­i­cal fear of be­ing un­safe af­ter his son was born. Ev­ery germ be­came a po­ten­tial fa­tal­ity, and ev­ery mail de­liv­ery could con­tain a pack­age of an­thrax.

Somyak — like the hand-wash­ers, the side­walk-crack-avoiders, the num­ber-ob­sessed — suf­fered from ob­ses­sive-com­pul­sive dis­or­der (OCD). I am sure no one who reads this book will ever again blithely re­fer to them­selves as hav­ing “a lit­tle OCD,” so har­row­ing are Be­g­ley’s de­scrip­tions of those who “know their thoughts are mad, yet aware­ness of the mad­ness brings no power over it.” She deftly draws a dis­tinc­tion be­tween OCD and ob­ses­sive-com­pul­sive per­son­al­ity dis­or­der (OCPD), whose num­bers in­clude the or­ga­niz­ers, the metic­u­lous per­form­ers, “whose drive for com­pe­tence has hy­per­tro­phied into per­fec­tion­ism,” even­tu­ally mak­ing them un­bear­able but ut­terly self-right­eous col­leagues, part­ners and friends. In­ter­est­ingly, she ex­plains that for those with OCD, some ex­ter­nal force seems su­per­im­posed on them, forc­ing their com­pul­sive ac­tions, but those ac­tions are at odds with their true iden­tity. In con­trast, the com­pul­sions of those with OCPD are in weird har­mony with their own tem­per­a­ment.

These may be the dis­or­ders of our anx­ious age, but we hardly cre­ated them. Be­g­ley takes us on a tour of com­pul­sions through his­tory and the fas­ci­nat­ing tran­si­tion as they moved from be­ing seen as a re­li­gious phe­nom­e­non to be­ing re­garded as a med­i­cal ill­ness. As a re­li­gious man­i­fes­ta­tion, com­pul­sions spanned from “scrupu­los­ity” — when prayer and ad­her­ence to what was per­ceived to be the will of God reached lev­els of mad­ness — to cases of de­monic pos­ses­sion, in which un­clean thoughts re­lent­lessly in­vaded oth­er­wise God-fear­ing minds. In one swift chap­ter Be­g­ley takes us on a brief his­tory of com­pul­sions from the 6th cen­tury through the Re­nais­sance, the En­light­en­ment — yes, of course, the in­evitable Freud — to present times. The grand sweep il­lus­trates the real take­away from this fine work: While some of us may have 10 cats, in the end, “there is no bright line be­tween men­tal ill­ness and men­tal nor­mal­ity.”

PHO­TOS BY IS­TOCK

CAN’T. JUST. STOP. An In­ves­ti­ga­tion of Com­pul­sions By Sharon Be­g­ley Si­mon & Schuster. 295 pp. $27

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