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.”
This is one danger that the current, hyperclinical story of illness seems designed to protect us from. If we are permeable the risks are infinite, and it’s comforting to imagine firm borders guarding our soft places. Though as Biss points out, when it comes to the body, those borders are largely imagined. For the mind, whose boundaries are literally imagined, the notion of borderlessness, of endless susceptibility to mimetic contagion, is overwhelming. But by denying it entirely, by constructing unimpeachable binaries (me/you, mind/brain, illness/self), we create an experience of the world that’s soothing but radically impoverished. If the truth lies somewhere in the middle, then the trick is the mapping. The other day, I found something in an old notebook that I don’t remember writing. At the end of a long list of notes I had given up and scrawled, in big letters, Where do I start and stop, is what I want to know.
Sometimes I imagine my fictional girl well again. Out of the hospital, electrodes safely implanted, and responding with promise. Depending on which hospital treated her, she might be sent to an outpatient group therapy called “narrative enhancement.”
Dr. Philip Yanos, who developed narrative enhancement therapy, explained to me that its function is to help mentally ill patients overcome internalized stigmas about their conditions. They learn about the ways they have been taught ideas like “I can’t have a normal life” or “I’m a bad person” or “There’s just something wrong with me.” Then they tell the stories of their lives over and over and over to one another. They talk about their lives before they got sick, and they talk about what it was like to be sick, and they talk about now. The therapist and the other patients repeat back to the patient the story she’s telling, but suggest more empowering language, and then the patient tells the story again but more like the way they said it.
The goal is to help patients integrate their notions of who they were before their sicknesses with who they are now. The task is to go back and find a thread of a story that can be pulled across the hospitalization or the psychotic break or the shock therapy, from then to now, from “her” to “me.” It matters what stories you tell yourself about yourself. When the integrity of the story is violated, peop
le get stuck at the point of fracture. They might re-form themselves around the brokenness, or they might restlessly circle forever, trying to understand what broke and why. The importance of the “coherent narrative self” is paramount: without it, even if the symptoms subside, you might never move on, which is another way of saying get well.
This is the story of how my obsessive-compulsive disorder began: When I was twelve, I had a friend who was going through some major psychological disturbance. She was a new friend, because I was new that year in school, and she revealed her problems to me incrementally, each confession like a gift signifying a deeper level of intimacy. First she showed me the box of safety pins and thumbtacks. She pulled them out of her backpack while we sat knee-to-knee on the bus and told me that she used them to cut herself. Next she told me she was bulimic and suicidally depressed. Eventually she told me that there was “a thing in her head” named Ailis, and that Ailis wanted her dead. Ailis, I gathered, was something between a voice and a demon. My friend talked about Ailis all the time, as if she were a mutual acquaintance. On days when I’d been a particularly sweet or loyal friend, she would smile at me meaningfully and say, “Ailis really doesn’t like you.”
We looked a little alike. (Her breasts were bigger.) We enjoyed the same things. (She turned me on to theater.) Teachers sometimes mixed up our names, and I was quietly pleased at being one of a pair. When she started telling me about thumbtacks and Ailis, I was fascinated and curious and, most of all, thrilled to be brought in. This was interesting, and presented an exciting challenge: I would love her to health. She would ask, “Why doesn’t it scare you to hear about these things?” and I would tell her blithely, “Because these problems are yours, not mine. You are you, and I am me.” This answer seemed to annoy her, and she would change the subject.
One night we were up late talking on the phone while I babysat for the neighbors. Vertigo, which I’d never seen, was on TV. In the film, Kim Novak’s character appears to be possessed by a ghost that is driving her to suicide. “There’s a woman in my head who wants me dead,” she confesses to Jimmy Stewart after trying to hurl herself off a cliff. “She talks to me all the time.” Stewart, a sucker for a blonde with a dark streak, falls in love anyway. Unfortunately, he isn’t able to love her to health. He takes her to a place she keeps seeing in her nightmares, an old Spanish mission on the coast, hoping to convince her that she can overcome her fears and exorcise the ghost, but she breaks away from him, dashes up the bell tower, and jumps to her death. This moment at the film’s halfway point marks a shift in focus from her possession to his obsession: her madness transfers to him. Unable to let her go, he is ruined by her.
It was during the bell-tower scene—Can this possibly be true? This is how I remember it—as Novak dashed up the steps, that my friend asked me again why I was never frightened by her confessions. I repeated my usual answer—you are you, and I am me—and she replied, “You never think you’re going to be one of these people, like me, until you are one.” Suddenly something came open inside me, and I knew she was right. I hung up the phone and had my first panic attack.
It’s uncanny how closely Novak’s confession (“There’s a woman in my head who wants me dead. She talks to me all the time”) matches my friend’s description of Ailis as I remember it, and how closely Ailis and Novak’s homicidal ghost resemble each other. The synchronicity unnerves me, particularly because I had 100 percent forgotten Novak’s imagined woman until I watched the movie again recently. For fifteen years—years during which I carefully avoided Vertigo—I remembered only the bell-tower scene, her gray suit ascending the stairwell and then falling past the window.
Did I drastically conflate memories and invent all the details of Ailis in the years since that night? Had my friend seen Vertigo, and was it she who suggested I watch it, hoping that I’d see she was not the first person to be visited by an Ailis, perhaps even hoping that I might be visited next—and if so, why? I’ve been asking myself these questions for a while now. Neither scenario makes sense. I am sure I didn’t invent Ailis, and yet the diabolical, premeditated manipulation required for the second scenario is so extreme I’d rather find it implausible. Any other possibility demands a coincidence on the level of an act of God. This is a fault in this story I can’t overlook and can’t heal. It just is.
I’ve been considering that uncanny confluence for months, but the thing I’ve been considering for fifteen years is the moment that came next. When my friend said, “You could be like me,” and I was plunged irreversibly into a new kind of fear—what was that? In so many ways the moment marks a before and an after, but I don’t really know how to talk about it. You could say it was ego boundary confusion. You could say it was mimetic contamination. You could say, maybe, that it was the beginning of real empathy. What I will not say is that it was only a chemical reaction, because while that might be correct, it isn’t true.
The summer I was seventeen and relapsing, I ran across a moment in the Phaedrus when Socrates theorizes that madness “is the channel by which we receive the greatest blessings . . . So, according to the evidence provided by our ancestors, madness is a nobler thing than sober sense . . . madness comes from God, whereas sober sense is merely human.”
Fuck you, Socrates, I thought.
I have said in my darker moments that I would never wish this mess on anyone, even the girl I got it from. (As if that mattered.) I will probably say this again someday, my whining masquerading as largesse, and I will mean it, but it is also true that I know something I did not know before, which is that we are more expansive than we imagine. And this expansiveness is both powerful and frightening. It can ruin you to madness, or fate or God or disease or demons or whatever you call the unknowables. But it is gorgeous too. It’s how the better unknowables get in. I think about being thirteen and hanging up the phone, standing frozen in the middle of the carpet in the neighbor’s living room while Jimmy Stewart watched Kim Novak’s body plummet to the terra-cotta and looking at him and looking at her with my friend’s voice ringing in my mind and feeling like I was being cracked wide at the sternum and the top of the head at once, being opened and emptied and invaded, aware suddenly of the way poor, monomaniacal Jimmy could be me and strange, possessed Kim could be me, and my friend with that creature in her head could be me too.
The warping force of that first panic was truly horrifying. Madness is not some holy blessing; pathology is not the same as pathos. And yet that vertigo has echoes in other rooms and reckonings I’ve seen, other moments of being opened and emptied and invaded by another person but beautifully, of flinging or being flung wide by radical, magical ego boundary confusions and quiet acts of self-extension over breakfast.
The other morning I heard a woman on the radio describe her art, enormous conceptual installations that involve manipulations of breath and light. As she was explaining her process, this artist used a phrase I’d never heard before: “thin places.” It’s a Celtic concept, one that stems from an old proverb that says, “Heaven and earth are only three feet apart, but in the thin places that distance is even smaller.” In thin places, the folklore goes, the barrier between the physical world and the spiritual world wears thin and becomes porous. Invisible things, like music or love or dead people or God, might become visible there, or if they don’t become visible they become so present and tangible that it doesn’t matter. Distinctions between you and not-you, real and unreal, worldly and otherworldly, fall away.
The original thin places were wild landscapes because the idea was born in the heaths of Connemara, a place that’s so austere and ancient, so full of twists and hiding places and divots a thousand years old, that it seems somehow likely you might poke a hole through to another reality. But the radio lady said that the delight of thin places was the unpredictability of their location. You can find them someplace with magic written all over it, like Connemara or the Himalayas, but they also pop up in dive bars, bedrooms, hospital rooms. They can appear and disappear.
But then, the thin places I’ve known aren’t always places, per se. Sometimes a thin place appears between people. Sometimes it happens only inside you.
“It could be said, even here, that what remains of the self / Unwinds into a vanishing light,” wrote Mark Strand for his friend Joseph Brodsky after Brodsky’s death. In this unwinding, the divide between Brodsky’s body and spirit, and even between the two men, blurs and disappears. “None of the boundaries hold.” Here, transversal takes on a quality of communion, the kind that arises when frontiers fall—a quality that seems inherent, even in the modern transversals of operating rooms where the new exorcism comes in rubber gloves and medical is miracle and knowing and nothing pass into each other and through. Before the word became the name of a medical technique, it was geometry’s nod to the importance of the in-between: a transversal is the line that connects other lines. You use it to discern parallels; taking the transverse of two lines reveals whether they’ll eventually touch.
The Best American Essays 2016 Page 18