Are you crazy enough to succeed?

By Jeremy Katz

updated 1:01 p.m. ET July 13, 2008

I sit in the glass-walled nurses' station, waiting for my day to begin. A steady stream of people — all living with obsessive-compulsive disorder, or OCD — approach the half door and utter some variation of "I have to go to the bathroom." The attractive young woman on duty smiles and hands over a small quantity of toilet paper, a squirt of soap in a specimen cup, and a paper towel with a cheery "Here you are!" This is what grade school must have seemed like to George Orwell.

Pretty soon I have to go, too. How could I not?

I'm here to interview the doctor, not seek treatment from him, so I'm directed empty-handed to a staff bathroom in which I discover four separate soap dispensers, a forest of paper products, and two signs about washing my hands — one to remind me to do it, and the other to tell me how.

I'm at the Obsessive Compulsive Disorders Institute (OCDI), a residential treatment center in McLean Hospital — Harvard's psychiatric center — to see if my own OCD problem wasn't just my secret but maybe also the secret to my success. All my adult life, intrusive thoughts have alternately halted my progress and saved my ass, and I'd finally like to separate the bad from the good.

The medical director at the center, Michael Jenike, M.D., is both a maverick and a pioneer in the OCD community. He founded this facility, the first of its kind, to help sufferers of what he considers the most agonizing of psychiatric disorders.

"I had a 17-year-old who had kidney cancer that was going to kill him in 5 or 6 months. He also had a bad case of OCD. He said he'd rather get rid of his OCD and live only 6 months, than get rid of the cancer and live with the OCD. That's when it first hit me: This is some serious stuff."

The people seeking treatment at OCDI do not have the minstrel-show version of the disorder acted out by Tony Shalhoub in Monk or Jack Nicholson in As Good as It Gets. The institute's residents are seriously impaired. They have the kind of shattering anxiety that would make the rest of the OCD world — roughly 1 percent of all adults, 2.3 million of them in the United States alone — want to scrub their hands. The real numbers could be even higher, because OCD may be underdiagnosed and undertreated. Half of all OCD cases are serious — and that's the highest percentage among all anxiety disorders. On average, people flail about for 17 years and see three or four doctors before they find the right care.

That horror aside, OCD has become cool. Perhaps it fascinates us because it forces otherwise normal people to carry out insane acts — acts that they know are insane. It has great dramatic tension. We secretly enjoy the dissonance of a perfectly rational man becoming convinced that he is fatally contaminated and washing his hands with bleach and a scrub brush, only to repeat the whole routine 10 minutes later. Paging Lady Macbeth.

And anyway, who wouldn't want a condition David Beckham has, even if it is his signature brand of mental illness? The popularization of the disorder has led to a heap of confusion. Everyone I know is "obsessed" or "compulsive" about something. And then there's the throwaway excuse of our times: "Oh, that's just my OCD."

This casual imprecision only adds to the confusion of talking about OCD. Sanjaya Saxena, M.D., an associate professor of psychiatry and behavioral sciences at the University of California at San Diego and the director of the school's OCD program, points out that "the meanings of 'compulsion' and 'obsession' as we speak of them in common parlance are not the same as the strict mental-health definitions." Obsessing about your work or your girlfriend doesn't mean you have OCD, and most people understand that "compulsively" keeping a neat desk or managing a stock portfolio is no big deal.

More to the point, those everyday fixations do not put you in danger of developing full-blown OCD. Even habits that are worrisome and possibly progressive, such as sex addiction, compulsive gambling, or overdrinking, fall within the spectrum of addictive behavior and not OCD.

Like our common, everyday infatuations, says Dr. Saxena, these habits persist "because they are rewarding in and of their own right." A true obsession, though, is "a recurrent, intrusive fear, impulse, or image that is distressing and anxiety-provoking," he says, while a compulsion is "a repetitive behavior done in response to an obsessional fear or worry and designed to prevent something bad from happening or to reduce distress."

If the behavior produces pleasure or a reward — even a strange or unhealthy reward — it's not a real obsession or compulsion, and it won't develop into one. Gerald Nestadt, M.D., a professor of psychiatry at Johns Hopkins, puts it this way: "The alcoholic may say, 'I shouldn't drink, but I love to,' whereas the person with a contamination obsession would say, 'I don't want to wash my hands, and I wish I could stop.' The reason the addictive person wants to stop is only because of the consequences, not the unwanted urge."

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