The Best American Essays 2016 (23 page)

This is more or less how grown-ups talked about what was wrong with me for several years after I was diagnosed with OCD at thirteen. I was, clinically, a nervous wreck, and many of my fears were about the transformation of my own mind. Was I insane? Was I doomed? Was this who I really was? Therapists and my parents were ready with reassurances that what was happening was only an accident of serotonin, a mysterious but correctable “imbalance” no more essential to who I was than a flu or a sunburn. I balked at taking medication, worried it would change who I was. “You have an illness, and this is just medicine to correct that illness,” I was told. “It’s like having diabetes. You wouldn’t refuse insulin because your body’s ‘authentic’ state is to have diabetes.” In the end, I couldn’t take the panic attacks, so I took the Prozac and, with it, this narrative of what was happening. It worked. The pills made my hands shake, but my mind was transformed back, more or less, to the healthy, stable state I remembered.

When I was seventeen, not long after weaning myself off Prozac, I relapsed. It happened sort of slowly. The thoughts came back, but at first I could fend them off. I blew past them with the buoyancy of a teenager whose life was going well. I was a few months away from leaving for what seemed like the most exciting college in the world, and I had my first boyfriend. Gradually, though, I stopped being able to ignore the thoughts. They came too quickly, and one day they seemed to bring real danger with them. Something darkly magical began to happen: I would gaze out at sunny days, beach days, Southern California sunsets, and feel the sidewalks begin to warp. The sky was cloudless, but something was terribly wrong. This feeling would steal an hour one day, and then I’d be myself again. The next day, two hours. As weeks passed, the sinister entered, and sick fear took over.

At the time I worked as a barista for a local breakfast-and-lunch place on the beach, pulling espresso and pouring green-tea lattes in an eight-by-eight-foot alcove off the restaurant’s kitchen. A wall obstructed my view of the line cooks, so I spent my shifts in isolation, handing cup after cup out a window the size of a cereal box to a man named Fernando who ate toast with whipped cream for breakfast. I’d be pouring cappuccinos and humming in my little wall-hole and then suddenly, as if from nowhere, a terrifying sentence would appear in my mind. Then another. Then a dozen. Panic attacks rolled in hourly. I began taping poems to the espresso machine to memorize, figuring that if I had to entertain thoughts that weren’t mine I might at least try to make them beautiful. I knew what was happening, but knowledge didn’t help. Diagnostic categories, the language of treatment—they weren’t enough. My teenage hair started to gray; my hands shook at the machine. I was growing desperate. One afternoon, I stepped into the back alley behind the restaurant, dialed my therapist, and told her that I thought I might not survive it.

I was understudying Juliet that summer for a local production of
Romeo and Juliet
, which meant sitting in on rehearsals and learning the lines and blocking. This should have been fun and exciting—and it was some days, particularly when the handsome blue-eyed actor playing Romeo made a point of flirting with me. (The regular Juliet was sleeping with Mercutio.) But most days it felt like something was very, very wrong. People often describe the way your body senses instinctually that you’re in the presence of a sociopath or in physical danger. The feeling can be confusing at first, because your body is telling you something that your rational mind doesn’t yet know.
Why do I feel so unsettled and skin-crawly when she’s so nice? This party is so fun; why do I feel like I have to get out of here?
I spent benign afternoons in rehearsal forcing myself not to bolt from the room. The theater, the restaurant, my bedroom—every place seemed menacing and uncanny. I spent hours in complex, circuitous rationalizations and self-assurances that boiled down to, in endless repetition: “But nothing’s wrong, but nothing’s wrong, but nothing’s wrong.”

Of course, something was wrong. The imminent danger was my misfiring sense of imminent danger, the revelation that the stability and habitability of the world can change as the mind changes. Minds are not reliably stable or habitable. They are subject to radical and sometimes horrible transformation. This is a danger of the world that is, as I was discovering, intangible but absolutely real.

Juliet has a monologue in the fourth act, spoken alone in her bedroom as she prepares to take a potion that will plunge her into a sleep so profound she’ll appear dead. She and Romeo have agreed that she’ll drink this potion, and once she’s been mourned and entombed in the family mausoleum he’ll come to wake her, and they’ll sneak out of Verona under cover of night and begin their life together. She’s resolved, even impatient, to go through with the plan and reunite with Romeo, but as she uncorks the vial, a thought occurs to her. “What if it be a poison, which the friar subtly hath minister’d to have me dead?” Fairly quickly she dispenses with this anxiety (the friar is a holy man and a trustworthy friend), but another pops up to fill its place: What if she wakes up before Romeo arrives? What if she suffocates in the tomb? Her nervousness takes on a tinge of panic. What if, worse yet, she wakes too early but does
not
suffocate, and is left alone in the vault “where, for these many hundred years, the bones of all my buried ancestors are packed: where bloody Tybalt lies festering in his shroud?” Then she strikes on the most frightening thought: what if she, surrounded by bodies and smells and “shrieks like mandrakes torn out of the earth, that living mortals, hearing them, run mad,” is so overwhelmed that she loses her mind? Will I “madly play with my forefathers’ joints,” she wonders,

And pluck the mangled Tybalt from his shroud?

And, in this rage, with some great kinsman’s bone,

As with a club, dash out my desperate brains?

O, look! Methinks I see my cousin’s ghost

Seeking out Romeo—

Quickly, she is hallucinating with panic. The loss of her own mind, imagined in the grotesque vision of herself fondling dead bodies in the dark, is made real by her own terror. The figure of Tybalt rises before her to kill Romeo. Desperate to make Tybalt—and the vision—stop, she seizes the potion bottle and, in a gesture that’s not a little suicidal, swallows it all. She collapses. End scene.

I dreaded this monologue, but I memorized it, made notes on it, even diagrammed it. I was convinced that the young woman playing Juliet, beautiful as she was in the balcony scene, failed to capture this movement from nervousness to wild, unhinged fear. But I also hoped I’d never have to perform the scene myself. It felt too close. Acting demands letting go of the self in a way that is usually considered self-destructive or pathological in real life; acting demands that you make way for other selves.

But then there’s the trick of coming back, of reconstructing the boundaries between your mind and your character’s mind. Sometimes this is hard to do. There are characters you don’t want to play because you know they’ll be frightening to expand into or difficult to come back from.

That summer when I was feeling very much like Juliet holding the potion, the therapist would tell me, “Just know that those thoughts aren’t you. That’s the OCD, it’s not you.” It was a kind gesture—she was offering me the illness narrative that reigns now, the one that constructs very, very firm boundaries between brain and self, illness and consciousness, self and other. I clung to that for a while, the notion that the maelstrom happening in my brain was not
of
me but
outside
me, happening to me. That there was a tidy line dividing “me” from “disease,” and the disease was classifiable as “other.” But then it became difficult to tell whether certain thoughts should go in the me box or the disease box—where did “I want to throw a rock through the kitchen window” belong? Eventually I could no longer avoid the fact that mental illness is not like infection; there’s no outside invader. And if a disease is produced in your body, in your mind, then what is it if not you?

Recently I found an image of Juliet and the potion, a film still taken from Franco Zeffirelli’s 1968 rendition that is famous even though it didn’t make the movie’s final cut. Juliet is shown in profile, dressed in a beautiful white nightgown with long sleeves draping to her waist. Her dark hair, a little tangled, hangs loose down her back like mine did when I was seventeen. She is kneeling at what appears to be an altar but is in fact the carved headboard of her bed; what seems to be the prayer cushion is her pillow, where Romeo’s head lay not long ago. We know she’s no longer a virgin, but she looks virginal, like one of the saints offering herself up. Her eyes are closed in fear or love or ecstasy, head tilted back in the light that glows down on her wrists and cheekbones. Her hands are clasped at her mouth in what looks like prayer, but if you look closely you can see the vial at her lips. She’s imbibing something, but what?

In a sense, what keeps an OCD patient rooted in the world of the neurotic rather than the psychotic, what tethers her to a certain agreed-on reality, the adherence to which seems to be our measure of functional sanity, is her healthy sense of the boundaries of her own ego—her ability to toggle complex and contradictory conceptions of self and other, real and not real, rational and irrational. She is obsessed, not possessed. She has insight. Most patients, though, have moments when their grip on me/not-me slips. In the medical community, this is known as magical thinking.

Obsessions often feel like the work of some cruel and sentient force equipped with its own devious logic, showering you with the exact thoughts and images you find most disturbing and devising new monstrosities as you defuse the old ones. Obsession knows you better than you know yourself. It outwits you. For this reason and others, insight is slippery even for diagnosticians. How is it defined, and how much of it is a patient supposed to have? Are lapses in insight allowed? What sort? How many? In his 1996 book,
Theoretical Approaches to Obsessive-Compulsive Disorder
, the clinical psychologist Ian Jakes writes:

The absence of reported insight cannot distinguish all obsessions from delusions . . . Further difficulties . . . may be raised by those patients who are classified by some diagnosticians as “partially deluded.” These patients are held to have beliefs that would otherwise satisfy the criteria for delusions but do not hold these beliefs with absolute conviction . . . How, then, are obsessions to be distinguished from partial delusions, and how are those cases of OCD where reported insight is absent to be distinguished from delusions?

Nearly twenty years later, these categories and definitions are still fluid: in 2013, the
DSM-5
altered OCD’s diagnostic criteria to allow for patients who have only “partial insight” or, within certain parameters, lack insight altogether.

Later in this section, Jakes describes a young woman whose case was typical but challenging theoretically. He gives her only five sentences, but the portrait is complex and, in a way, complete. D.S. was twenty-nine and afraid that she might lose possession of her own thoughts, that they might travel from her head down her arms and escape through her fingertips into the world. She worried that she would leave a trail of ideas and images in her wake, clinging like residue to everything she touched. D.S. knew, for the most part, that this wasn’t possible, but sometimes she wasn’t sure. Her frontiers, the places where she stopped and everything and everyone else began, seemed changeful and pervious. Jakes calls this phenomenon “ego boundary confusion.”

I love this young woman with anxious fingers. I wonder about her—what she looks like, where she is, whether she ever got better. If she is still living, she is forty-seven now. Her fears have such poetic overtones; they riff on common fears of contagion, which are often amplified and uncontrollable in patients with OCD. “Our bodies are not our boundaries,” writes Eula Biss in
On Immunity
. “Fear of contamination rests on the belief, widespread in our culture as in others, that something can impart its essence to us on contact. We are forever polluted, as we see it, by contact with a pollutant.” This notion extends past the physical realm of germ contamination and into metaphor. We worry about the “bad seed” and fear that someone’s awful luck, lousy attitude, or even insanity will “rub off” on us.
*
At the same time, the things most precious to us often risk—or demand—this kind of contagion. The “sacred” places of the body are the ones where membranes are exposed: our mouths, our eyes, our genitals, the places where we connect with others and make ourselves vulnerable to them.

Accordingly, it is just as common to look for membranes where there are none. We trace our fingers over the faces or bodies of people we love as if we wish we could leave unspoken thoughts and feelings behind like residue. We place our foreheads together and press gently, as if to see whether we can merge that way. We struggle toward each other out of our little meat suits.

Sometimes it works. There is a kind of love where you start to lose track of where you start and stop. It isn’t typically sustainable over long periods—it can come and go—but this version of total connection, or total mutual contamination, feels in the moment like the central operating miracle of the universe. Near the end of Toni Morrison’s
Beloved
, the prose breaks down in an ecstatic rush:

I am Beloved and she is mine . . . how can I say things that are pictures I am not separate from her there is no place where I stop her face is my own and I want to be there in the place where her face is and to be looking at it too a hot thing

This is an exact description of that love. In the book, though, it is also a description of a furious, sublimated obsession, a daughter haunting the mother who killed her. It’s a story about love but, just as importantly, about horror; a thwarted love so ferocious it manifests and turns its object from memory to flesh.
Beloved
is in one sense a fable about the chiaroscuro of staying half-merged to someone else, the redemptive power and the unholy danger of “not separate from.”