Authors: David Adam
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For those who deserve an explanation
Watch your thoughts, for they become words.
Watch your words, for they become actions.
Watch your actions, for they become habits.
Watch your habits, for they become character.
Watch your character, for it becomes your destiny.
An Ethiopian schoolgirl called Bira once ate a wall of her house. She didn't want to, but she found that to eat the wall was the only way to stop her thinking about it. She didn't want to think about the wall either; in fact, she was greatly disturbed by the ideas and images of it that dominated her mind. The only way she could make the thoughts of the wall go away, and calm the anxiety they caused, was to follow a strange and unbearably strong urge to eat it. So she did; day after day, for year after year. By the time she was 17 years old she had eaten eight square metres of the wall â more than half a tonne of mud bricks.
Bira lived in the capital city, Addis Ababa. Her father died when she was young and she grew up with her mother. Bira had eaten mud every day for as long as she could remember, since she was a little girl. It became worse when, as a teenager, she started to take it only from the wall of her home. As she did so, the images and thoughts came more vividly and more often, which only intensified her need to eat to find relief. The mud made Bira constipated and gave her severe stomach aches. Ethiopian traditional healers tried to treat her with prayers and holy water and advised her simply to stop eating the mud. But she couldn't. She couldn't stop her thoughts about the wall, and so she couldn't stop eating it.
One day, Bira couldn't cope any more. Her distended stomach throbbed with pain and her abdomen was tight with cramp. Her throat was scratched raw from the straw in the bricks and her body was riddled with parasites from the soil. In tears, she walked to her local hospital. At the time, Ethiopia had eight psychiatrists for a nation of 70 million people. Bira was fortunate. She managed to see one of them. She told him that she needed help. She knew her thoughts were wrong, but she knew she couldn't stop them alone.
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An average person can have four thousand thoughts a day, and not all of them are useful or rational. Mental flotsam comes in many forms. There are the irrelevant words, phrases, names and images that flash unprompted into our minds, often as we perform some mundane task. There are earworms: tunes that wedge themselves in our heads, more prosaically called stuck-song syndrome. And there are negative thoughts â âI cannot do this,' âI must quit' â the sworn enemy of sports psychologists everywhere.
Then there are the very strange thoughts: those occasional, random and unprompted ideas that seem to emerge from nowhere and stun because they are vile, immoral, disgusting, sickening â and just plain weird. The seductive question âWhat if?' What if I was to jump in front of that bus? What if I was to punch that woman?
These kinds of thoughts are more common than most people realize. Ask around. A friend of mine has a need to check the toilet bowl for rats before he sits. Another unplugs the iron and places it in an unusual place when he finishes with it, so he knows for certain the answer when his mind demands later: Are you sure, really sure, that you turned it off? One tortured soul spent an evening unable to ignore the repetitive thought that he may have scrawled across an application form for his dream job the word âcunt'. Most people have these kinds of strange thoughts. Most shake them off. Some people don't.
When we cannot make our strange thoughts go away they can lead to misery and mental illness. The friends I mention above did not convert their strange thoughts in this way. But I did.
I turned mine into obsessive-compulsive disorder.
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The day that the Brazilian racing driver Ayrton Senna died in a crash during a Grand Prix in Italy, I was stuck in the toilet of a Manchester swimming pool. The door was open but my thoughts blocked the way out.
It was May 1994. I was 22 and hungry. After swimming a few lengths of the pool, I lifted myself from the water and headed for the locker rooms. Down the steps â one, two, three â ouch! I had scraped the back of my heel down the sharp edge of the final step. It left a small graze, through which blood bulged into a blob that hung from my broken skin. I transferred the drop to my finger and a second swelled to take its place. I pulled a paper towel from above the sink to press to my wet heel. The blood on my finger ran with the water as it dripped down my arm. My eyes, of course, followed the blood. And the anxiety, of course, rushed back, ahead even of the memory. My shoulders sagged. My stomach tightened. It had been four weeks since the incident at the bus stop, and, as much as I told myself that it no longer bothered me, I was lying.
I had pricked my finger on a screw that stuck out from the bus shelter's corrugated metal. It was a busy Saturday afternoon and there had been lots of people around. Any one of them, I thought, could easily have injured themselves in the way I had. What if one had been HIV-positive? They could have left infected blood on the screw, which then pierced my skin. That would put the virus into my bloodstream. Oh, I knew the official line was that transmission that way was impossible. The virus couldn't survive outside the body. But I also knew that, when pressed for long enough, those in the know would weaken that to virtually impossible. They couldn't be absolutely sure. In fact, several had admitted to me there was a theoretical risk.
Standing quietly in the toilets of the changing rooms, still dripping wet, my swimming goggles in one hand and the bloodstained paper towel in the other, I ran through the sequence of events at the bus stop once again. I told myself how there hadn't been any blood on the screw when I had checked it, or at least I didn't think there had been. Oh, why hadn't I made absolutely sure?
Someone else banged through the door into the swimming pool changing rooms. They whistled. I looked at my finger. Wait a minute. WHAT THE HELL HAD I DONE? I had put a paper towel on a fresh cut. OH JESUS CHRIST. There could have been anything on that paper towel. YOU STUPID BASTARD. I looked at the paper towel, now soggy. THERE IS BLOOD ON IT. Well, of course, it's my blood. HOW CAN YOU BE SURE? Someone with Aids and a bleeding hand could have touched it before me. OH JESUS. I threw it into the bin, pulled a second from the dispenser and inspected it. No blood. That helped, a little. No blood on the next one either. BUT THEY COULD HAVE DONE. I pulled the original paper towel back from the bin. It was bloody. IF THIS IS SOMEONE ELSE'S BLOOD THEN WHY ARE YOU PICKING IT UP? I quickly washed my hands. AND WHAT IF THEY BLED INTO THE SINK TOO? DON'T TOUCH YOUR FUCKING HEEL. DON'T TOUCH YOUR FUCKING HEEL. No chance of that. WHAT IF THAT ISN'T EVEN THE PAPER TOWEL YOU THREW IN THE BIN? It could be someone else's paper towel that I was handling, someone else's blood. I looked in the bin. I couldn't see any other paper towels with blood on them. WHAT ABOUT THAT ONE?
The whistling man was ready to swim. He came to the sink, grabbed a paper towel, blew his nose and threw it into the bin. I did the same. He looked at me. I smiled. He didn't. He walked away. I didn't. He finished his swim and left. I couldn't.
Cycling home later, I was pleased with the solution I had found. I was getting somewhere! I heard the birds and felt the spring sunshine on my face. Well, of course I couldn't have caught Aids from scratching myself on the screw at the bus stop. That was ridiculous, I could see that now. I had nothing to worry about on that score. I pulled my swimming trunks from my bag and placed them on my bedroom radiator. I rummaged in the wardrobe for my winter gloves and put them on to unfold my swimming towel and carefully retrieve the damp and bloodstained paper towel wrapped inside. I placed it on the radiator next to the trunks. It would take about ten minutes, I guessed, before it would be dry enough to check properly. Then I reached back into the bag and found the other crumpled paper towels, the ones I had lifted from the bin, and laid those out on my desk. I would check those as well, check them properly (impossible in the changing rooms), and then surely that would be that. Then I could put all this behind me. Phew! I took off the gloves and turned on the TV. The Grand Prix was about to start.
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Those are my strange thoughts. That is my obsessive-compulsive disorder. I obsess about ways that I could catch Aids. I compulsively check to make sure I haven't caught HIV and I steer my behaviour to make sure I don't catch it in future. I see HIV everywhere. It lurks on toothbrushes and towels, taps and telephones. I wipe cups and bottles, hate sharing drinks and cover every scrape and graze with multiple plasters. My compulsions can demand that after a scratch from a rusty nail or a piece of glass, I return to wrap it in absorbent paper and check for drops of contaminated blood that may have been there. Dry skin between my toes can force me to walk on my heels through crowded locker rooms, in case of blood on the floor. I have checked train seats for syringes and toilet seats for just about everything.
As a journalist, I meet a lot of people and shake their hands. If I have a cut on my finger, or I notice that someone who I talk to has a bandage or a plaster over a wound, thoughts of the handshake and how to avoid it can start to crowd out everything else. My rational self knows that these fears are ridiculous. I know that I can't catch Aids in those situations. But still the thoughts and the anxiety come.
The psychiatrist who Bira saw in Addis Ababa told her she had obsessive-compulsive disorder (OCD) too. She had persistent thoughts that were inappropriate. She could not ignore or suppress these thoughts, which made her anxious. To reduce and prevent this anxiety she developed compulsive behaviour. The compulsions fuelled the obsessions. Together, the obsessions and compulsions took up so much time and caused such distress that they disrupted her life.
Most people have heard of OCD but there is much confusion about the condition. It's commonly seen as a behavioural quirk. In fact, OCD is a severe and crippling illness, and one defined as much by the mental torment of recurring strange thoughts as physical actions such as repeated hand-washing. Bira was diagnosed with moderately-severe OCD. Yes, a girl who ate an entire wall of her house was thought to have it only
-severe. There are plenty of people out there who have it worse. Bira spent about two hours a day thinking about the wall and eating mud. Yet, on average, OCD patients can waste up to six hours a day on their obsessions and four hours on their compulsions. A Brazilian man called Marcus had OCD that centred on obsessive thoughts about the shape of his eye-sockets, so much so that he was compelled to touch them constantly with his fingers. Marcus prodded himself blind.