by Tracy Kidder
When the obsession with contamination first crawled into Alan, there was a lot of talk in the news about the herpes virus. Alan worried that he might catch it. But that was just a particular form of a general fear that OCD provokes. Earlier in the century “cleaners” like Alan fretted about syphilis. By the mid-1980s many worried about AIDS. Obsessive-compulsive disorder almost certainly predates the germ theory of illness. Various symptoms were described in medieval times. Martin Luther and Samuel Johnson may have suffered from it.
The ailment has an eerie quality. Accounts of victims’ lives often sound familiar, like myths or fairy tales, and their obsessive thoughts resemble what Western cultures now call superstitions—for instance, the belief that things once connected can, when separated, still affect each other, that fingernail clippings or locks of hair can be used to harm the people they came from. Or the belief that thoughts can in themselves cause calamities. The person who knocks on wood after feeling lucky may not be doing something very different from what Alan felt compelled to do when he washed and washed his hands after touching a doorknob.
Freud described a case of OCD and theorized about it, but he was clearly stumped. Current hypotheses about the cause include psychodynamic, chemical, neurological, and neuroanatomical explanations, and there is tantalizing evidence for each, as well as for a genetic predisposition to the ailment. The cause or causes still aren’t known. During the 1980s, though, some treatments appeared. Psychotherapy didn’t seem to work. But it was now known that a class of drugs called serotonin-reuptake inhibitors—the famous Prozac is one—helped many victims. So did a form of behavior modification called exposure and response prevention therapy. The local psychiatrist whom Alan consulted called him back a few years later with this news. Since then Alan had sent away for information from the Obsessive Compulsive Foundation. He had spoken on the phone to some of the leading experts. And before writing to the Hemlock Society, he’d made an effort to get well. He checked himself into a mental hospital, McLean, near Boston. But a while after he returned to Northampton, Alan said ruefully, “McLean’s works great. But only if you spend the rest of your life living at McLean’s.”
Americans began to feel ashamed if they lived above a store in an old downtown. As they moved to the suburbs and merchants stopped residing above their shops, upper floors grew seedy in the collective view and, soon enough, seedy in fact. But here in downtown Northampton the trend had been reversed and an old pattern rediscovered: shops, restaurants, theaters, nightclubs at street level; professional offices, hair salons, dance studios on second floors; and apartments up above. Nowadays people paid high rents to live downtown. A few kept veritable penthouses overlooking Main Street. And some of the mystery of the place had been revived—for people glancing up at windows, in their private thoughts imagining others’ private lives.
Upstairs in the old tipsy-looking building near the corner of Main and Pleasant Streets, unbeknownst to anyone, Alan had an accident. He got a small cut on his shin. It became infected. The infected leg began to swell. Then the other one did, too. Soon he couldn’t get his pants or shoes on. He ordered larger ones over his decontaminated phone. The skin on his shins itched maddeningly. He couldn’t keep from scratching. When he saw that the skin had begun to ulcerate, Alan told himself, “I’m dying. And this is a good way to go, because even though it’s painful, it avoids the embarrassment of suicide. I’ll be dying of a systemic infection.” The skin on his lower legs began turning black. It didn’t look human to him anymore. His calves looked like the bodies of dead fish, covered with plates of dry dead skin. He couldn’t sleep. He’d drop off for a few minutes, then awake in pain. And then one morning he woke up in his fastness over Pleasant Street, and heard himself say, “I don’t want to die.” He couldn’t walk very far anymore. He’d have to find a doctor with a nearby office.
“You don’t know who I am, but I’m a lawyer here in town. I suffer from obsessive-compulsive disorder, and I need to be examined. I know I have a serious infection. I can’t take my clothes off. I can wear loose-fitting clothes. I can pull up my pants legs to show you, but you can’t touch me directly. You have to wear rubber gloves. And I can’t touch anything that’s been on the ground, so you may have to help me put my socks back on when you’re done. It’s really bizarre. I understand if you’re not going to be able to do this.”
“Come on over,” the doctor said. “We’ll see what we can do.”
The doctor was alarmed. He confirmed Alan’s own diagnosis. “You have cellulitis. You’re going to die if it’s not treated. The next stage—and I mean within the next two minutes—this goes to blood poisoning, and when the poison hits your organs, you’re dead. You’re at the point now where it’s going to happen. You need to be in the hospital.”
That was impossible.
The doctor didn’t dare to treat him outside. It would be extremely poor medical practice.
Alan said he’d make up a release and sign it.
Reluctantly, the doctor prescribed enormous doses of oral antibiotics.
Alan was afraid of ingesting pills, but he took these, for weeks on end, and gradually the infection receded. He had saved himself. Afterward, alone in his squalid rooms, he took stock. He had already let the doctor touch his leg. He had already done what the uncontrollable part of his mind had told him was even more awful: he’d taken pills. Alan could not say why pills should seem dangerous when food prepared by others didn’t. He didn’t make those ridiculous distinctions. His illness did. Contemptibly, cravenly, he’d obeyed its orders for a decade. But now he had actually ingested pills on his own. He called his old psychiatrist at McLean, whom he hadn’t spoken to in over a year, and he asked for a prescription for Prozac. “I don’t know if I’m ready to take it,” Alan said. The psychiatrist sent him the prescription. Alan filled it. For a time the bottle sat unopened on his dresser.
Clinicians who treat victims of OCD talk about courage. You have to understand, they say, that a truly potent set of fears lies behind the bizarre and sometimes comical-looking behavior of a person who starts weeping at the idea of throwing away an old newspaper clipping, or checks the same lock two dozen times, or rushes for the sink after touching a doorknob. Victims who decide to get better do what most people never have to do. In one kind of therapy, they have to expose themselves deliberately and repeatedly to what truly terrifies them. In another, they have to take a drug, an act equally terrifying to some. Hardest of all, they have to begin. Alan poured himself a glass of water and shook out a capsule of Prozac. Then he sat on his bed for a while, just holding the water and the pill, one in each hand, contemplating what might happen if he combined them in himself.
He wasn’t thinking, “I’m about to do something brave here.” He didn’t feel very afraid of contamination by pill just now, as he sat on his bed, staring at Prozac. At the moment his fears were rational. He had read about the drug and knew that it reduced the sex drive in a fairly small percentage of people, and he didn’t care at all about that. He’d been celibate for almost a decade. But this little tablet in his hand was powerful, he knew. It would change him. He thought, “If I take this mind-altering medication, I may suddenly feel lost. I may lose that sense of continuity of self, that ongoing, ageless voice that is a sense of self. This may make me function at a lower, or on a different plane. I don’t know if, when I take this, I’ll end up barking like a dog.”
And then he thought, “Screw it. How much worse can it be, whatever it is?”
The mornings grew chilly, the great river vaporous. Mist hung in the folds of Mount Holyoke, burning off a little later each day. The natural beauty of Northampton seemed clearest and most poignant now, in the views that opened after leaf fall under north wind skies—the yellow cornfields all laid flat, the river running by, the murmurings of history. The greenness had so recently departed from the streets and southern hills, and in the lengthened shadows on the sidewalks you sensed the many months before greenness would return. Time to look �
�down cellar,” as people from Northampton say, for the storm windows and snow tires, and time for the better-organized to start their Christmas shopping. At Northampton’s facilities for the homeless, the waiting lists grew longer.
Throughout its first century, Northampton had paid citizens to house and feed the local poor. But that tightly woven, religious farm town hadn’t looked kindly on indigent strangers. At one point the town meeting had even voted to evict about a hundred families who had not properly applied for the right to settle. (No records show how many actually departed, only that some certainly stayed on.) Eventually Northampton established a poorhouse. The one still standing at the end of the nineteenth century had all but rotted away beneath the beds of the inhabitants before it was rebuilt. Nowadays distant governments subsidized about 10 percent of local housing—just about the percentage that the federal bureaucracy deemed proper. State and federal money financed a number of halfway houses for the addicted and variously handicapped, and the shelter for homeless veterans at the veterans’ hospital out in Leeds. Many of the people who lived in the city’s privately owned boardinghouses and apartment complexes paid their rents out of government stipends. But the state and national social service apparatus was too big and too distant for its local extensions to serve everyone who came to town looking for shelter. To catch some of the overflow, Northampton had established its own homeless shelter, and, to catch the overflow from the shelter, churches set up cots in their basements from late fall until spring. Local charity paid most of the costs.
On the afternoon of October’s last Sunday, a banner in Pulaski Park proclaimed, SHELTER SUNDAY. Again this year, several wealthy residents, who preferred anonymity, had each put up $10,000 for the local homelessness programs. Today more than a hundred citizens were out searching for the remainder, knocking on doors and holding out coffee cans. On Main Street, in front of coffeehouse row across from the park, tourist shoppers, coffee drinkers, Sunday strollers flowed around a stout figure dressed in a red blazer and billowing skirt. She, too, held out an empty coffee can. “Hi. Would you like to contribute to our homeless?” Some parts of the current swung wide to avoid her, averting their eyes. Others eddied around her, digging in their pockets. “Good afternoon, Your Honor.” “Hi, Mayor! Nice of you to volunteer.”
Down on Pleasant Street a very thin black man leaned against a building, huddled in layers of coats. “Jesus loves you,” he murmured to passersby. Leaves blew past him in the chill October wind and into the duck ponds at Look Memorial Park, around the trunks of the great oaks in Childs Park, across the lawn in front of Forbes Library. The wind rustled the informational handouts and tally sheets on the long church-basement-style table set up in the middle of Pulaski Park. The mayor dumped her take on the table—$75.35—and, rubbing her hands to warm them, turned to the Gazette reporter who stood by, awaiting quotes. “What I like about Shelter Sunday, besides the money it brings, is that it raises the community’s consciousness,” she said in a voice high and cheery. She went on, more somberly, “Whatever the combination of underlying causes of homelessness is, they’re getting worse. At least in this area.”
Northampton’s homeless shelter was called the Grove Street Inn. It stood about a mile from downtown, out past the ruins of the state mental hospital’s power plant, on a rutted asphalt road—a clapboarded house, like a New England farmhouse, and painted the appropriate white, but not recently. The Inn sat all alone at the bottom of a long hill, its only near neighbor an abandoned house. Residents sat on the front porch on broken-down furniture, smoking—the shelter was a part of Northampton: no smoking allowed inside. The interior rooms were clean but unadorned, furnished with hand-me-downs. It seemed like a place without promise. Residents got only temporary refuge. Three months was the limit.
But when it had room, Grove Street accepted anyone in need. It didn’t ask for virtue. Colonial Northampton had warned out indigent strangers. Contemporary Northampton tried to accommodate them. The Inn amounted to a principled, communal gesture. Some citizens grumbled, of course. Set up shelters for riffraff and you’ll attract more riffraff, they felt. But once in a while a place like Grove Street could be good for more than the conscience of a place. After all, St. Peter says, “Be not forgetful to entertain strangers: for thereby some have entertained angels unawares.”
In summertime a few years back, a man carrying a little airline bag shambled up to the door of the Grove Street Inn. He was short and stocky and clothed like many people down on their luck. His jeans hung too low, revealing the cleft of his butt. He had a broad, copper-colored face, not quite handsome but full of interesting things—close-cropped, jet-black, curly hair; a black mustache and a little compensating fringe of hair below his lower lip; mysterious dark brown eyes. He didn’t seem to know that when he smiled, his ears wiggled slightly, but it was obvious that he knew he had charm—from the sweet look he’d put on, cocking his head a little to one side, as he listened to what other people had to say. He laughed with a smoker’s deep huskiness, in low piratical tones.
Asked for identification, he would produce from various pockets all sorts of paper—business cards and crumpled remnants of letters and, mixed in with the rest, a Massachusetts driver’s license, a Social Security card, and a birth certificate. These identified him as one Samson Rodriguez, an American citizen born November 28, 1950, in Puerto Rico. He had been laid off from his job as a loom operator in a factory down in Holyoke. Samson had worker’s compensation coming. He stayed at Grove Street on Northampton’s hospitality just long enough for his check to catch up with him, then moved to the rooming house at 96 Pleasant Street downtown. A lot of the people at Grove Street were sorry to see him go. Surely this was one of the shelter’s best uses, to put up a good-natured blue-collar worker temporarily short of funds.
It didn’t take Samson long to feel at home in downtown Northampton. His feelings for the place weren’t all that different from those of other recent settlers, the board-certified surgeons and lawyers and people with fancy degrees and well-heeled married couples with children and the many recent graduates of the region’s five colleges who lingered on. Like them, Samson was smitten by downtown—its prettiness, its liveliness, and above all its mannerly, safe atmosphere. He stood on the stoop of the rooming house, watching the traffic move through downtown, and it wasn’t long before he realized he was listening for something and not hearing it. Down south in both Holyoke and Springfield, the two biggest cities nearby, drivers honked at each other all the time, like a bunch of barking dogs. But not here, Samson noticed, even when the traffic was thick on Main Street. “Check this out,” he thought. “No horns.” And down in Holyoke and Springfield—in the parts of them where he’d lived, anyway—arguments and fights were always breaking out. Not here. He studied the people walking around downtown. “The people up here, they’re, like, mellow,” he remembered thinking.
Everyone noticed this peaceable quality, and some had theories to account for it. The demographic explanation was least convincing. Northampton wasn’t rich and it didn’t have a wall around it to keep out people who’d caused trouble elsewhere; actually, its many social service agencies invited a number of such people in. Jane Jacobs’s famous theories about street life had to do with great cities, but maybe some of them applied in little downtown. Like her ideal urban neighborhood, it was used at almost every hour, and this ensured not just liveliness and profit but also the constant presence of “eyes on the street.” Because downtown had become a place of many live-in owners, there were always people around with a stake in what went on in public and in keeping up the place. And perhaps downtown proved the theory that the right kind of well-kept surroundings encourage civility.
The place lacked those features that make many urban streets look like little war zones. The shopkeepers didn’t cover their windows with steel grates after hours. Indeed, they left things outside that could easily have been defaced—flower boxes by the sidewalks, canvas awnings over storefronts. Fragile things le
ft out at night seemed to declare that the place was safe, and maybe they helped to make it safer. Maybe people inclined to vandalism and assault usually behaved themselves here, not just because they realized there was a good chance of getting caught, but also because they didn’t want to mess up something they, too, enjoyed. Clearly, something like what sociologists call social norms had been set in motion. A resident hesitated to honk at another driver, perhaps thinking, “I might know that idiot’s wife.” Visitors sensed, as people rarely do in a big city, that the place had a general code of correct behavior almost unanimously endorsed.
Maybe, as Northampton’s city planner said, all the theories about downtown were correct. Samson, who had grown up in the Latin American faith called Santería, favored a quasi-religious explanation. He borrowed some of his theory from a Christian lay preacher, a boarding-house reverend, who told him that an angel guarded Northampton from “the malice power,” the evil influences that wanted to migrate up the river valley, from the cities to the south and into Northampton’s streets. Looking around, Samson decided that geography also played a part, assisting Northampton’s guardian angel. From spots between buildings and over rooftops, he studied the Holyoke Range. One cloudy night he saw a reddish glow in the sky above those hills, and his suspicions were confirmed. Those hills were definitely involved. They clearly helped to block the malice power from seeping into town.
Obviously, something was doing that good work. “The only thing the malice power could do here is a light touch,” Samson would say. “You know. The gay and lesbian thing.”
Evidence accumulated. When he learned that Northampton had a lot of churches and hosts of counselors, psychologists, and psychiatrists, and New Age mind- and body-workers practicing such disciplines as the ancient Chinese art of skin-rolling, Samson felt sure he’d landed in a specially designated place. Clearly, deep forces had chosen Northampton as a place for healing. And maybe it was no accident that he’d been drawn here. He felt he needed some help. In Holyoke, he’d been smoking far too much crack cocaine. He loved and hated the drug. “If you take the best day of your life and multiply by twenty, that’s the first stage. If I’m on a run, I don’t want to eat or sleep. But by the third day, it’s just maintaining.” By the third day his thumb would become an open sore, from flicking the abrasive wheel of his lighter over his crack pipe.