"We’re opening up the pearly gates!“ Jonathan Grayson smiles when he says this, and his smile is contagious. Were it not, the nearly 100 conventioneers who have followed the doctor outside on this damply warm night in July would probably be fleeing for the safety of their sanitized hotel rooms. As they stand behind a Marriott a few miles north of Houston, the rickety door of a shed swings open and the nervous flock beholds what their smiling shepherd has brought them to see.
It’s a Dumpster. It’s full of food scraps. A fruity aroma of rot wafts up from its belly. “All those who’d like to get better,“ Grayson bellows like a revival-tent preacher, “touch this!“ They line up like congregants waiting for a warped sacrament. One by one they approach the Dumpster—wincing, clenching their jaws, even fighting back tears—and when they get to it, they smear their fingers and palms along its rim. “One whole finger,“ a girl says proudly, holding it up, after she has passed through the fragrant sanctuary. “Oh, you can do better than that!“ another woman tells her. “One whole hand!“ She leads the girl back to the receptacle.
The bravest members of the throng stroke the Dumpster and run their fingers through their hair. A spasm of release washes over their faces. When everyone is done, Grayson rallies them again—“Come in closer! Everybody cross-contaminate!“—and they press together in the moonlight, arms draped over shoulders, in a germy group hug.
It’s safe to say the average human being would be repulsed by the idea of spending his Friday night communing with heaps of garbage, but for these folks even the prospect of a simple hug might be enough to induce paralysis. The people roaming the grounds of the Woodlands Waterway Marriott struggle with a mental illness that is estimated to afflict as many as one in 50 Americans, many of them exceptionally bright and ambitious: obsessive-compulsive disorder. Among them are hoarders and hand-washers, thermostat-checkers and symmetry-seekers, germ-avoiders and chronic fingertip-tappers, and they’ve come to Texas for this weekend’s 14th annual conference of the Obsessive Compulsive Foundation.
Thanks in part to pop-culture depictions such as The Aviator, As Good As It Gets, and Monk, the source of their torment has become oddly chic these days. OCD has become a catch-all term for anal-retentive fussiness—“Dude, I always save my receipts from the ATM, I’m sooo OCD!“—when in fact the people who endure its maddening headspace despotism might as well be locked down in a maximum-security prison. Traveling to a gathering of fellow sufferers, then, is like going on a psychic furlough. This is the first time some of them have ever met, let alone hugged, let alone swapped microbes with, anyone else laid low by their strange and stubborn disorder.
Dr. Grayson, who runs the Anxiety and Agoraphobia Treatment Center, outside Philadelphia, and published the book Freedom from Obsessive-Compulsive Disorder in 2003, represents the cutting edge of a practice known as exposure therapy, and his Willy Wonka-style romp through germland will be, for many, the habit-shattering highlight of the weekend. The Dumpster is only part of it. OCD comes in many varieties; not everyone who has it is afraid of contamination. Some are fixated on the irrational thought that they’re going to hurt someone. They might even booby-trap their own homes so that they don’t wake up in the middle of the night and murder their kids. Some are fanatical pack rats, cramming their homes with ziggurats of clutter. Some lust for order and can’t stand to see a single button out of place. Grayson, who is gray-bearded and extroverted and, at 55, looks as though he could have once been a Doobie Brother, has an “exposure“ for each one—a moment when they’re encouraged to confront the thing they fear.
“Okay,“ Grayson barks as the group floods into a parking garage, “who is worried that their actions could cause harm to others?“ Two women step forward. Normally if they were merely to touch a car, these women would get obsessed with the idea that the car is doomed to crash and kill its occupants. “In a mad, crazed rush,“ Grayson says, “could you start kicking these car tires?“ All of us, including the two women, descend upon a Toyota and proceed to give the radials a vigorous thwacking.
Onward. “Do we have any hoarders?“ Grayson asks. “We’re going to do something special with you.“ There’s a canal that runs beside the Marriott. The doctor leads the crowd to it, and at the edge he looks into their eyes and says, “Do you have a dollar with you? Is it worth a dollar to get better?“ People open their wallets and pass bills to the front. “The trouble with hoarding,“ Grayson says, “is that letting go of things is a loss.“ With that, he rips up the money and throws the scraps into the canal. From the group come gasps.
You can’t tell right away. If you wander into the Woodlands Marriott by accident, a quick glance around might lead you to imagine that about 500 members of the Ecumenical Fellowship of Church Deacons are in town for their yearly prayer powwow. It’s not just that obsessive-compulsives look “normal.“ It’s that a lot of them are abnormally tidy. Hair clipped. Shirts ironed and tucked in. Straight posture. Precise diction. Only by stepping back and scanning the room do you catch the signs that something is slightly off.
There’s the man striding across a hallway who stops at a table, freezes, and taps out a Morse code of arpeggios with his fingertips before he allows himself to move along. There’s the guy whose lunchtime ritual is as elaborate and mysterious as the Latin Mass: He keeps nudging his plate back and forth by a few millimeters, unwrapping a fresh set of plastic cutlery for the next round of bites, and studying the bottom of a cup of ice for minutes at a time. There’s the supersize bottle of hand sanitizer placed inside the entrance to each restroom. This might be the one convention in America where rampant handshaking is considered a faux pas.
They’re sort of like Rotarians from another planet, which makes sense, because the OCD beast is commonly said to have an appetite for successful strivers with higher-than-average IQs. “Anecdotally, yes, there’s something to it,“ says Dr. Katherine Muller, an OCD expert at the Montefiore Medical Center in New York. “My theory is that OCD takes a certain level of smarts. Most folks can have random thoughts and dismiss them pretty easily, but the OCD person looks at their thoughts, they think about their thoughts. It’s meta-cognition: thinking about thinking.“
Although there appears to be a genetic basis for OCD, what triggers it is often a disorienting encounter with a transitional aspect of life: marriage, parenthood, a new job. It can flare up when a person is in his twenties or thirties, and when it does, that perfectionist pressure to get things right can, at least at first, bear the markings of a professional asset. “OCD runs on a spectrum, and if it’s just enough to give an edge in a career, it can actually be helpful,“ Muller says. “But once it hits that tipping point, it can become a real detriment.“ Here at the conference are several lawyers, along with editors and scholars and a willowy Manhattan model. Smith, a 25-year-old Ivy League-educated economist, looks as freshly scrubbed as an extra from Happy Days. (Like most of his comrades at the conference, he asked to have only his first name published.) He wears a red-striped Brooks Brothers oxford, pressed khakis, and Sperry Top-Siders, and it’s only after you’ve spoken for a few minutes that you realize he’s bound in a psychic tourniquet.
“There’s a façade,“ Smith says. What’s underneath the façade is rituals, and they have become so rigid that the tiniest jolt to his routine can undo him. “Breakfast is at 7:30 exactly,“ he says. “12:43 sharp for lunch. Dinner’s at 6:48 exactly. No deviations.“ If he misses the right tick of the clock, he says, “I’ll punish myself and I won’t eat the full meal.“ He drives only on certain roads. He shops at only one supermarket—Whole Foods. “If someone picks up my book, I’ll just toss it in the trash, because it’s useless,“ he says. “It’s contaminated.“ His grooming rites can devour two hours. “Shaving, brushing my teeth, putting on clothes, taking them off again, and then putting them back on so they feel right. If I miss my morning routine, I’ll call in sick to work, because I can’t function.“ Physical relationships are almost impossible. “My problem,“ he says, “is I get disgusted. I’ll be making out with a girl and I’ll just fixate on something about her that’s just nasty, like a zit. Or I’ll be like, God, her nose is disgusting, I can’t deal with this.“ When Smith talks, the words gush forth, but when someone else is speaking, his tics emerge. He emits grunts of pent-up breath. Sometimes in private moments he squinches his face into a grimace and flicks out his tongue.
Like many of his fellow sufferers, Smith is swimming in an alphabet soup of treatments—acceptance and commitment therapy (ACT), exposure and response prevention (ERP)—and medication (“I’m on the highest dose of Zoloft you can have“). And although he quips that OCD has become “the new designer disorder,“ that’s a good thing for anyone who wants relief from it. A couple of decades ago OCD sufferers had a hard time getting the right diagnosis and help, but now the disorder even has its own blonde, poised, 20-year-old spokesbabe, Elizabeth McIngvale. She gives one of the keynote speeches at the conference, along with Julian Swartz, a basketball star and coach from Wisconsin, and Jeff Bell, a popular San Francisco Bay Area news-radio anchor who’s just published Rewind, Replay, Repeat.
In the book, Bell, 43, describes himself as having been a “quirky, high-strung overachiever“ in his early years, but when his extraordinary focus began to pay off and he’d established himself as a radio star in the early nineties, the disorder nearly wrecked it all. “I would spend hours fact-checking and grammar-checking and checking every possible comma and period of a 60-second story—I could barely get these things on the air,“ Bell says. “Because I have this obsessive drive to get to the bottom of stories, it’s made me a pretty good investigative reporter. On the other hand, I get caught in this horrific cycle of having to check and recheck every minute detail about a story I’m working on. That’s the built-in irony of this. To a certain point, yes, it drives you. And then you cross some threshold, and now it’s holding you back.“
Rick, a 46-year-old lawyer from Houston, talks about becoming so overwhelmed by hoarding and checking—did I shut the refrigerator? Is water running in the shower?—that he had to stop working for a while. “At the end of the day you begin to worry about what you’ve accomplished,“ he says, “and the reality is you haven’t accomplished anything.“ When he finally got counseling and his support group came over to clean out his apartment, they loaded a truck with about 45 bags of junk. For others, merely lurking on the edges of a noisy room is a form of shock therapy. “It’s hard for me to be around crowds of people, so it’s hard for me to be here,“ says Cameron, a 20-year-old sufferer from San Antonio with extreme anxieties about airborne germs. “I can’t open doors. Well, I can, but I have to go like this“—he wraps a shirt sleeve around his hand. While he talks, Cameron stands about four feet away from you, and he yanks his shirt over his nose and mouth in order to block out an imagined barrage of bacteria. So extreme is Cameron’s dread of germs that for a while he made a habit of searing his fingertips with a lighter.
For Spencer, a 17-year-old student from Kentucky, routines as simple as getting to class or finishing his homework have become complicated ordeals. When he walks down the hallway at his high school, he feels impelled to step on every single crack. If he’s writing a paper, it takes him at least 30 seconds to inscribe the perfect capital A—“I have to erase a lot,“ he says. With OCD there are countless forms and variations, and in parts of the Bible Belt, the disorder frequently takes on a Pentecostal tinge. “My problem is scrupulosity,“ says George, a 32-year-old teacher from Tennessee. “It’s a religious obsession. I might have a thought flash through my mind that I’m praying to Satan instead of God. It’s illogical stuff, but it still distresses you. Even going to a church service, I never know what’s going to pop into my head.“
This kind of behavior, says Jeff Bell, is what distinguishes real OCD from garden-variety, check-the-gas-cap stuff. “A lot of people who think they know what it is really don’t understand the severity of the debilitating aspect of all this,“ Bell says. “I have one of the neatest closets in America. I get great pleasure out of organizing my clothes. I’ve got white hangers for short sleeves, blue hangers for long sleeves. This actually is not part of my OCD.“ The reason, Bell says, is that organizing his closet brings him a strange kind of bliss, whereas other habits—the ones he has trouble stopping—cause him agony. “I would never be late for work because my closet wasn’t neatly organized,“ Bell explains. “Now, contrast that with my need to pick up rocks and twigs from sidewalks because I’m convinced people will trip on them and die. Could I imagine being late for work because I didn’t pick up a twig? Yes. I mean, it’s happened.“
Dan from Detroit is a checker. Stubbly and weary, he sits in a hallway lounge area wearing an Adidas T-shirt and track pants and fiddling with a pack of Marlboros and a cup of black coffee. At 36, Dan admits to having squandered hours of his life. He has a fear of stepping on electrical cords and causing an accident, and will often worry about tripping on cords that aren’t even there. “I have a fear that I’m gonna pass a counterfeit bill and get in trouble,“ he says. “I check money before I go to the store.“ He’ll hold a 20 up to a lightbulb and flip it over again and again. He’s afraid he’ll start a fire with a tossed cigarette butt, so he’ll stare at a stubbed-out smoke for several minutes to make sure there’s no red ash. Perhaps it’s no surprise that Dan has resorted to marathon binges of self-medication. “I had a really serious drinking problem, but that’s behind me,“ he says. “When I did drink, the OCD went away about 99 percent. I would go on binges for three to five days. When I ran out, I was so desperate to get more. If I’d kept it up I probably would’ve landed in prison.“
It’s that threat of prisons both mental and concrete that explains why many of these folks are willing to devote a summer night to Jonathan Grayson’s adventures in Dumpster-petting and dollar-shredding. Even though his virtual camping trip amounts to a crash course in exposure therapy (“We’re not really doing treatment there, we’re kind of doing a demonstration,“ the doctor says), Grayson is quick to point out that “we do have people who will have a permanent gain from that. It’s like those things where people walk on hot coals. For some people even having the experience of that is eye-opening.“
Real exposure therapy can turn into a lifelong practice. First a patient goes through an intensive program of treatment, which usually lasts a few weeks or months, and then, if he’s following orders, he’ll continue with a daily dose of exposures on his own, sort of like a psychological trip to the gym. This can get bizarre—you’ll hear about sufferers who set aside an hour every day to smear their hands with gunk from dirty dishes—but it pays off, Grayson says. “There will be times when they are symptom-free,“ the doctor says. “They really won’t be thinking about it at all.“ OCD sufferers are prone, like addicts, to relapse, but evidence suggests that that initial taste of freedom can go a long way toward breaking them out of the brain rut.
As the coup de grâce in Texas, the doctor leads a posse of men into a restroom. He kneels next to a urinal. One after another, the men place their fingertips on the porcelain lip of the pissoir—the very spot where one’s urine tends to dribble. Then Grayson places a white Tic Tac in their hands, and they pop the mint into their mouths. (One of the most fearless guys skips the mint altogether—he taps the urinal and then licks his fingers with his tongue.) “I didn’t like that,“ says Mike, a 36-year-old sufferer from Houston. Sweat is beading on his brow. “I don’t like that kind of contamination.“ He’s not supposed to. The point is to get comfortable with discomfort; with OCD, the only real cure is to care just a little bit less. “For some of you,“ Grayson tells them when they’ve made it through the ceremony of the urinal, “tonight might be the beginning of a miracle.“