Pure O: the truth about a disorder that’s all in the mind
Singer George Ezra has thrown a spotlight on a little-known form of OCD that sparks distressing thoughts. Luke Mintz reports
A16-year-old Nick Shuttleworth was touring Canada with his orchestra when the thought popped into his head for the first time, uninvited: “I want my parents to die.” He didn’t, of course. He loved his parents deeply, and had no idea how his mind had conceived of such a dastardly thought. It had arrived as if from nowhere – like Tourette’s inside his head, he says.
“It was the worst thing I could think at the time,” remembers Shuttleworth, a 42-year-old engineer who lives in Worcester with his wife and nine-year-old daughter. “It really troubled me … I just didn’t know where it had come from. I remember spending the rest of the day trying to reason with this phrase in my head.”
But the distressing thoughts kept coming. It marked the beginning of a two-decade battle with a mental illness that Shuttleworth describes as “Pure O”, a form of Obsessive Compulsive Disorder. It is a poorly understood condition, campaigners say, but that could well change now that Brit Award-winning pop singer George Ezra declared this week that he, too, is a Pure O sufferer.
Ezra, 27, said he spent many years compulsively thinking of the “worst thing” he could possibly say in any social situation, leaving him wracked with guilt for being a “horrible” person. “I heard about [Pure O] and instantly there wasn’t any doubt in my mind,” he told the BBC’S How Do You Cope? podcast. “I said: ‘That’s it. That’s what’s going on. That’s what I’m experiencing.’ In hindsight, this is something that I had my whole life.”
Ezra has sought therapy, and says the condition has influenced his songwriting.
Pure O, short for “purely obsessional”, is not yet recognised by doctors as a medical term – instead, it was coined by OCD sufferers to describe a form marked more by thoughts than by actions. When we think of OCD, we usually think of irrational behaviours like washing your hands again and again, or turning a light switch on and off dozens of times to stop your family from dying. But people who say they have Pure O experience unwanted, distressing thoughts without the physical actions to relieve them.
And these “intrusive thoughts”, as they are called by doctors, can be terrifying. Peter Klein, a psychotherapist in Richmond, west London, says one of his patients used to have the same mental image, again and again, in which she stabbed her baby and partner, even though she had no ill feelings towards either, and had never shown any proclivity towards violence. Another “very common one” is for patients to become terrified they might be a paedophile, even though they have no reason to think so.
“Usually, the intrusive thought will relate to something that’s most important to them,” he explains.
“Someone may walk past a child, and think, ‘Oh, I noticed that child, why did I notice them?’ You probably just noticed them because they walked past. But they think: ‘How do I know that I didn’t notice them because I like children, how can I be sure of this?’” Intrusive sexual thoughts – like heterosexuals who are afraid of “turning out” to be gay, or married straight people who are terrified of being attracted to a friend – are particularly common, as explored by Channel 4’s recent provocative drama Pure.
Everybody has the occasional intrusive thought. Have you ever stepped on to a railway platform and suddenly wondered what would happen if you jumped in front of a train, for example? But Pure O sufferers say they encounter these distressing thoughts constantly, and that they are often haunted by the horrific mental images they summon.
Shuttleworth says his OCD can be triggered by something like unloading his dishwasher. “If I’m putting knives or scissors away, and I’m near my wife, sometimes I think: ‘Am I going to stab my missus?’ I have no compulsion to, it’s more the fear of the image.”
Doctors are sceptical that Pure O is a distinct strain of OCD. Klein thinks the very name Pure O is a “misnomer”, because even those of his patients who think their illness is “purely obsessional” still tend to carry out some form of cleansing action. A married straight man might become convinced that they are gay, for example, and so will “test” their theory by re-examining in their head all of their recent encounters with men. This mental “test” is itself a form of cleansing behaviour. “There are compulsions involved, not only obsessions, so it’s not really ‘pure’ O,” Klein says.
Prof Gus Baker, trustee of The Brain Charity, says: “Pure O OCD is a relatively new term, coined by the individuals who have it. Many doctors do not currently use the term when making diagnoses.” A patient who says they have Pure O, he adds, “would still likely be treated using standard, traditional treatment methods, the same that are used for other types of OCD”.
Regardless, some patients maintain that the term is a helpful way of explaining that OCD can occur mostly within one’s own head.
Ezra’s fear is that he will say the “wrong” thing in a social situation – a remarkably common hang-up for OCD sufferers, especially among Ezra’s millennial generation, whose exposure to constant social media may well have made them more attuned to others’ opinions.
Gaby Hasham, 25, who works for a mental health charity in London, says her own Pure O reared its head in her final year of Durham University, when she began to obsessively replay conversations, terrified that she might have offended a friend or relative.
“If I had a long conversation with a friend, my brain was always two or three sentences behind, because I’d be repeating everything they’ve said and I’ve said, to make sure it was right. Or I’d analyse everything I’d said, and [check] it wasn’t weird or strange. My brain would tell me: ‘Check that bit again …’ I’d have to reel back through hours and hours of conversation. It was tiring.”
She decided to seek help after attending a ball. “By 2am, I was trying to balance about 20 conversations in my head. I was very distressed. My friend was like, ‘Are you OK?’, and I just exploded on her.” She was diagnosed in 2016 with OCD, and her condition improved after she received Cognitive Behavioural Therapy – the most common way of treating OCD, in which patients are taught to resist acting on their intrusive thoughts.
A patient who believes irrationally that they have been infected by a bug, for example, and then obsessively checks their “symptoms” on Google, will be taught to avoid the internet – thus breaking OCD’S vicious cycle. CBT is offered on the NHS, but can come with a wait of more than six months; or through private practice.
It can often sound like a cliché, says Hasham, but the more public figures like Ezra who talk about OCD, the easier it will be for patients to come forward. “The feeling of relief once I had a name for my condition was like nothing I’ve ever felt before. I think raising awareness and taking its power away by giving it a name can only be a good thing.”
‘Pure O is a term coined by people who say they have it – not doctors’