Can't Just Stop

by Sharon Begley

  Thank you for downloading this Simon & Schuster eBook.

  * * *

  Join our mailing list and get updates on new releases, deals, bonus content and other great books from Simon & Schuster.

  CLICK HERE TO SIGN UP

  or visit us online to sign up at

  eBookNews.SimonandSchuster.com

  CONTENTS

  Introduction

  CHAPTER ONE

  What Is a Compulsion?

  CHAPTER TWO

  Obsessive-Compulsive Disorder, or Is Fred in the Refrigerator?

  CHAPTER THREE

  With Treatment, from Blood in a Snowbank to Hollywood

  CHAPTER FOUR

  In the Shadow of OCD: Carrying Conscientiousness Too Far

  CHAPTER FIVE

  Video Games

  CHAPTER SIX

  Smartphones and the Web

  CHAPTER SEVEN

  Compulsions Past

  CHAPTER EIGHT

  Compulsive Hoarding

  CHAPTER NINE

  Compulsive Acquiring, or I’ll Take Two

  CHAPTER TEN

  Compelled to Do Good

  CHAPTER ELEVEN

  The Compulsive Brain

  Acknowledgments

  About Sharon Begley

  Index

  INTRODUCTION

  JOHN MILTON, HAVING SET HIMSELF the modest task in Paradise Lost of “justifying the ways of God” to man, was blind for most of the time he was creating his epic poem, from 1658 to 1667. So every morning, once that day’s scribe—one of his three daughters or, sometimes, his nephew—arrived, he began dictating another batch of what would be the ten thousand-plus lines of verse describing the fall of humankind, lines that he crafted every night and memorized until daylight broke. (A painting hanging in the main branch of the New York Public Library, Mihály Munkácsy’s 1877 oil, “The Blind Milton Dictating Paradise Lost to His Daughters,” depicts Mary, Deborah, and Anne facing their father around an ornate table, ready to midwife the birth of one of western literature’s seminal works.) If that day’s designated amanuensis was late, according to an anonymous biographer, “hee would complain, Saying hee wanted to bee milkd.” The bovine metaphor could not be clearer: like a cow aching to release her store, Milton had a palpable need to be unburdened of the memorized lines of verse that filled him with anxiety until he could get them out.

  Hemingway’s drive to write apparently had similar roots. In the characteristic monosyllabicity that inspired countless Papa-imitation contests, he put it this way: “When I don’t write, I feel like shit.”

  Both writers’ work sprang not, or not only, from a deep creative impulse and genius that could find expression nowhere except the page, but from something deeper, darker, more tortured. They were driven to write, compelled to get words down on paper in order to keep the psychic pain they felt at bay. Yet far from being unremittingly debilitating, even destructive, their compulsion to create brought them literary immortality. The rest of us made out pretty well, too: generations of readers have found comfort in the Fall and promised redemption of humankind, or inspiration in the self-sacrifice of Robert Jordan as the forces of the Spanish fascists approached.

  There are endless motivations for human behavior, from the basic drives for food and sex to more complicated ones such as ego gratification, reputation building, altruism, compassion, envy, anger, a sense of duty, and simple pleasure, among so many others. But none of these explain behaviors that we feel irresistibly, often inexplicably, driven to engage in: compulsions. Compulsions come from a need so desperate, burning, and tortured it makes us feel like a vessel filling with steam, saturating us with a hot urgency that demands relief. They are an outlet valve, a consequence of anxiety as inevitable as burst pipes are a consequence of water freezing within a building’s plumbing. But while compulsions bring relief, they bring little enjoyment, and while with one part of our brain we desperately wish to stop them, with another we are desperately afraid of stopping.

  Compulsively checking your smartphone for text messages, stabbing the thing the moment you step out of a dead zone and get a signal; frantically trying to beat a level in a video game; acquiring more and more stuff, no matter how much you already have and how unfulfilled each previous hoard has left you—we feel compelled to engage in these behaviors and more because, if we don’t, we feel the anxiety that drove Milton to regurgitate his memorized lines or that caused Hemingway to feel like shit.

  In that sense a compulsive behavior is true to the word’s etymology. We describe as “compulsive” someone who reads, tweets, steals, cleans, watches birds, lies, blogs, shops, checks Facebook, posts to Instagram, eats, or Snapchats not only frequently but with the urgency of one who is not fully in control of his behavior. Similarly, we describe as “compelling” motives, novels, reasons, evidence, television shows, arguments, scenarios, advertisements, melodramas, speeches, and candidates that create a sort of behavioral black hole: their attraction is so powerful, if we try to keep ourselves from being drawn in, if we try to look away or pull away, we feel a shiver (or more) of anxiety that can be assuaged only if we give in. Action that is compelled is brought about by pressure or even force, often against the will of the person executing the action; behavior that is compulsive arises from an irresistible, urgent drive or urge, one that loses none of its potency from the fact that it often clashes with one’s conscious inclinations, wishes, and even deep desires. Our compulsions arise from a mortal ache that we will go to what seem the craziest extremes to soothe.

  The “Lunatics” We Deserve

  British historian Roy Porter (1946–2002) observed in a 1991 essay titled “Reason, Madness, and the French Revolution” that “every age gets the lunatics it deserves.” And ever since the 1947 publication of W. H. Auden’s poem The Age of Anxiety, ours has been an era defined by dreads both existential and trivial, societal and personal. Although Auden wrote in the immediate aftermath of Hiroshima and Nagasaki, the sources of anxiety in the twenty-first century go well beyond the specter of nuclear holocaust.

  They include global warming and other forms of environmental destruction so powerful that humans have become like gods, replacing the “nature” in “natural disaster” to become the agents of floods, wildfires, hurricanes, droughts, and even the inexorable rise of the seas. They include the possibility that terrorism could again descend from an azure September sky or turn places as quotidian as an airport check-in, a subway, a concert hall, and a marathon’s finish line into carmine killing fields. The sources of anxiety include, too, relentless technological advances that seem to outpace the ability of the human brain to keep up, from the banal (Should I be on Snapchat or WhatsApp, or both, or . . . ?) to the consequential (What cancer treatment from which doctor at which hospital should my mother get?). The minute-by-minute monitoring of whether one is Hot or Not and how many likes that clever post on Facebook got can ignite a smoldering anxiety that feels as if our blood has turned to lava and is seeking the weakest escape portal. Parents a couple of generations ago did not stress out over getting their children into the “right” preschool, nor did yesterday’s teenagers and new graduates agonize over once-trivial choices such as what summer job to get or extracurricular activities to sign up for. And before the likes of Google Shopping and FareCompare, buying decisions did not bring the stress of wondering, If I had just clicked through to the next page, or tried a different site, would I have found a better, less expensive version of what I wanted? No wonder some of us must compulsively check Zappos.com’s 517th pair of pumps before we can enter our credit card number.

  While many of those anxieties afflict a nano-slice of American society, other forms are widespread. Experiencing, or merely witnessing, such massive economic disloc
ations as the financial crisis of 2008–2009 or the waves upon waves of layoffs that crashed onto America’s workplaces beginning in the 1980s made us see job and financial security, not to mention career stability, as illusory, fragile, a thing of the past. A job for life, whether on an assembly line or in an office, has become as anachronistic as a pay phone. The insecurity inherent in twenty-first-century global capitalism permeates every corner of life, which seems to be cartwheeling beyond our control: play by the rules, act responsibly, and you can still wind up jobless, partnerless, and unfulfilled. How can we not feel anxious?

  No wonder that by 2015 more U.S. college students suffered from anxiety than from depression, which had long been the most common mental affliction in this population. And no wonder that the malaise engulfed adults, too: according to the National Institute of Mental Health, in any twelve-month period 18.1 percent of U.S. adults suffer from anxiety intense enough to be considered a disorder, compared to 6.9 percent who suffer from major depression. And Google’s Ngram Viewer, which charts the frequency of words appearing in English-language books, shows that from 1930 to the turn of the millennium use of the word compulsive rose eightfold.

  That suggests a corollary to Porter’s maxim: if every age gets the lunatics it deserves, then our age of anxiety deserves those who are in the grip of a compulsion.

  For compulsions, according to a growing body of scientific evidence, are a response to anxiety. Suffused and overwhelmed by anxiety, we grab hold of any behavior that offers relief by providing even an illusion of control. We can’t keep a private equity firm from saddling our company with so much debt it has to lay off half of us, or an online date from regarding us as one of countless fish in the sea. We can’t keep power plants in China from burning so much coal that the resulting greenhouse effect turns a minor storm into a hurricane bearing down on our community, and we can’t keep an anthrax-toting fanatic in Karachi from hopping a plane to New York. So we do what we can and control what we can, compulsively cleaning or checking, hoarding or shopping or surfing the net or wearing out our thumbs with video games. We cling to compulsions as if to a lifeline, for it is only by engaging in compulsions that we can drain enough of our anxiety to function. Against tectonic social and economic forces that feel as uncontrollable as King Canute’s tides, we seize on anything that might restore a sense of agency. Compulsions are the psychological equivalent of steering into the skid: counterintuitive, initially scary, but ultimately (at least for some of us) effective.

  While extreme compulsions appear odd, irrational, pitiable, and even self-destructive to outside observers, they are responses to otherwise unbearable and even paralyzing anxiety. According to a new, still-emerging understanding, even the craziest-looking compulsions are adaptive, even pragmatic, and all too human. A compulsion is at once biological balm and curse, surface madness (or at least eccentricity) and profound relief.

  Consider compulsive exercise, which nearly half of those with an eating disorder are driven to engage in. After all, what feels more like it should be within our control than our own body?

  Carrie ArnoldI thought so. An overachieving college freshman, she began exercising regularly for fitness, but also because she was “stressed out of [her] mind” by the pressures of college and by being away from home for the first time, she told me. Whenever the anxiety got too bad she would “lace up [her] running shoes and head to the gym.” Still, her exercise habits were hardly extreme—maybe thirty minutes a day, four or five days a week.

  A few months into college, however, Carrie’s already-intense regime exploded into something more. “I started exercising late into the night and it stopped being social,” she recalled. “And it was almost all for stress relief.” Every day, for hours each day, even as she carried a full load of courses, she ran and made the college gym her second home, powering herself up the stair stepper and making the stationary bike whine—all on about four hours of sleep a night.

  Exercise, Carrie found, helped dampen the waves of anxiety that washed over her. As a result, she felt anxious if she wasn’t hitting the gym every day. By the end of her junior year her compulsion had spiraled out of control: she was exercising more in a day than is recommended for most people in a week and had lost so much weight that when her mother saw her for the first time in months, she told her she looked skeletal. “I felt I had to burn so many calories, or do so many sit-ups, and if I burned one less or if you stopped me from doing it I’d get really upset,” recalled Carrie, who chronicled her compulsion to exercise in a 2004 book, Running on Empty: A Diary of Anorexia and Recovery. “I also had to use a specific machine, and if I didn’t, I’d get frantic.” Even when physicians ordered her to drastically cut back on exercise, “I couldn’t just stop,” she said. The compulsion to hit the Stairmaster felt like the most intense itch imaginable, one that can be relieved only by moving—intensively, energetically, even manically.

  After graduating, Carrie threw herself into exercise like a dying woman reaching for a life preserver. She awoke at night and was seized by an urge to exercise; she did squats in the bathroom and ran for miles before the sun rose. “It was a horrible anxiety that got translated into, ‘I have to exercise,’ ” she told me. “Exercise had become the way I managed my life. The worse I felt, the more miles I needed to run. I constructed my whole life around it. I had no friends or social life. The only point was seeing how many calories I’d burned, or the numbers of steps or miles I’d done.” She tried to dial back, but “every time I ended up on the floor, shaking and sobbing. Exercise was the only thing that seemed to lower my sky-high levels of anxiety.”

  * * *

  When I began this book, I viewed life-altering compulsions as foreign and almost frightening: people who scrub their hands compulsively and repeatedly; people who play video games so compulsively their thumbs seize up; people who shop so compulsively they wind up filing for bankruptcy. But in the course of my research and reporting, two things happened.

  For one thing, as I got to know people who, at first blush, fit the “crazy” category, their compulsive behaviors didn’t seem unreasonable at all. To the contrary, their compulsions seemed like understandable responses to angst that would otherwise eat them alive. They weren’t crazy or even, necessarily, broken; they were coping, they were keeping themselves together, and they were probably functioning better than if they had allowed the anxiety to swallow them. The more I listened to the hoarder whose story most moved me, the more I found myself thinking, Yup, if I had experienced what you had then my home, too, would be bursting from an accumulation of stuff serving as the only bulwark between me and a slough of despond. Just because you’re compulsive about something doesn’t mean your brain is broken.

  The second epiphany I had is that although people with the most extreme compulsions seem like outliers, the anxiety that drives them to those extremes is universal—and underlies milder compulsions, too. Actively behaving to allay anxiety is a deep and ancient impulse. That realization changed how I viewed myself and those around me: behaviors that once seemed thoughtless, selfish, controlling, or damaging now seemed like understandable responses to fear and anxiety. The mild compulsions of people who don’t come close to meeting the diagnostic criteria for a mental pathology arise from the same sort of dread that drives severe ones. The compulsions serve the same function, too. It’s just that deeper, more acute anxiety demands more extreme, and often self-destructive, compulsions to alleviate it, while milder anxiety has only enough power to compel us to never let go of our phones, to do the laundry according to specifications only we understand, to insistently arrange our desks this way and this way only.

  * * *

  Compulsions that accomplish this are as bizarre and varied as the human imagination.

  A few years ago a sixty-five-year-old man came to the attention of a mental health clinic in Amsterdam because, for sixteen years, he had felt an irresistible compulsion to whistle carnival songs. His wife had contacted a mental health cl
inic “close to desperation from listening to the whistling of the same carnival song for nearly 16 years,” Dutch psychiatrists wrote in a 2012 paper in the journal BMC Psychiatry. “It would go on for 5 to 8 hours every day” and got worse when he was tired. Mr. E., as they called him, had been treated with the antidepressant clomipramine, which cut the carnival-song whistling to a mere three to four hours a day, but the side effects were intolerable. When the psychiatrists visited his home, they were “immediately confronted with the clear and perfectly in tune whistling of the same song, almost without interruption.” The doctors probed for the possibility of obsessive-compulsive disorder, but Mr. E. assured them that no obsessive thoughts instigated his compulsive whistling. “He did feel annoyed and anxious if he was asked to stop,” however.

  If compulsive whistling, why not excavating? Britain’s “Mole Man,” William Lyttle, felt compelled to dig massive, winding, deep tunnels under his house in East London, tunnels sixty feet long and some as deep as twenty-six feet under the house he inherited from his parents. “I first tried to dig a wine cellar, and then the cellar doubled,” he told reporters just before his 2010 death. After local authorities, fearing the house would collapse, evicted Lyttle, engineers removed thirty-three tons of debris from inside the tunnels, including three cars and a boat.

  Such extreme disorders might make one think compulsive behavior is something that afflicts other people, a mental illness that few of us have to worry about. But data show otherwise. As many as 16 percent of U.S. adults (38 million people) engage in compulsive buying, Stanford University scientists found in a 2006 analysis. Between 2 and 4 percent (up to 9 million people) are compulsive hoarders. Over any twelve-month period, 1 percent of us suffer from obsessive-compulsive disorder (OCD), the dark prince of anxiety disorders.

  Even more of us find ourselves in the grip of a compulsion that falls short of something disabling enough to qualify as a mental disorder—in fact, some compulsions are downright adaptive, helping us lead our lives or perform our jobs more effectively and efficiently (or so we tell ourselves). You probably don’t know anyone who whistles carnival songs compulsively, tunnels under his house, or feels compelled to have repeated CT scans. But I bet you know many people who feel compelled to reach for their smartphone as soon as they wake up in the morning . . . or even, as one high-powered literary agent did, to demand his smartphone the moment he came to after open-heart surgery. Our compulsive behaviors can be so mild as to go unnoticed by everyone except those who observe us most closely and astutely.