Thinking too much

OBSESSIVE Compulsive Disorder generally makes us think about compulsive behaviour like hand-washing, arranging items neatly, or checking over and over that things have been unplugged.

So much so that daily living becomes an endless round of obsessive thinking followed by compulsive actions. It’s exhausting, little understood, anxiety-ridden, and not much fun for either the sufferer or those around them.

A friend of mine, J, has the kind of ‘classic’ OCD outlined in Dr Judith Rapoport’s book The Boy Who Couldn’t Stop Washing. J is a washer and checker; her OCD flares up in response to difficult situations (a miscarriage, a relationship break up), and manifests itself by making her feel that she is ‘contaminated’. During an episode, which can last weeks or even months, she won’t share her drinking bottles with anyone, or touch anyone unless she has washed her hands raw in antibacterial gel.

J also finds it impossible to leave her house without checking things again and again. It is distressing for her, and baffling to those who don’t know her (which in turn triggers feelings of shame) but she has suffered intermittently from OCD all her life and uses cognitive behavioural therapy to manage her symptoms.

OCD and its spectrum disorders — body dysmorphic disorder, bulimia, hair or skin picking, etc — affects around one in a hundred people. The average sufferer copes alone for around 11 years before seeking help. There is no cure for the condition, only management.

But what if your OCD manifests itself in a way that is not clearly recognisable to either yourself or the medical profession? What if you are too scared to leave the house because, in the words of poet and academic Joanne Limburgh, your thinking means that “an icy pavement equals permanent brain injury”? What if your thinking prevents you from driving, cycling, or using trains and planes? If you are so set upon by thoughts of either deliberately or accidentally harming your baby that you are afraid to bathe them, care for them, or leave the house with them?

Limburgh, who is 40 and lives in Cambridge, has written The Woman Who Thought Too Much: A Memoir of Obsession and Compulsion. It is an incredibly beautiful book of unflinching honesty — devoid of self pity, self laceration, or emotional manipulation, it is a memoir full of self-awareness and dark humour, in which Limburgh manages to make everything — from her childhood to neuroscience — compellingly fascinating. When I put it to her that I had no idea that this strain of OCD existed, she replied, “Neither did I — which is why I wrote this book.”

Limburgh was born in 1970 into a middle class London family. “If I’d been born a hundred years earlier I could have had a promising career as a hysteric,” she notes dryly, while describing a happy loving home life marred by her seemingly inexplicable anxieties. As a child she recalls being afraid to take her shoes off before school assembly, because her catastrophic thinking — that the shoes would be misplaced, that she would be shamed in front of the whole school, that everyone would think she was stupid or bad, or both — caused her to have what she calls the ‘unbearable feeling’. This unbearable feeling followed her throughout her education, her time studying philosophy at Cambridge University (her academic career flourished in spite of her as yet undiagnosed OCD), and into her otherwise happy marriage with Chris, the father of her son.

“This kind of thought process is called ‘rumination’,” she explains. “I was never a washer or a light switch checker, which are the better known symptoms of OCD — I am a ruminator.”

In order to alleviate her unbearable feeling, Limburgh underwent years of therapy — Freudian and Jungian — plus cognitive behavioural therapy (CBT) and Prozac. They all helped, especially the last two.

“If OCD is like someone shouting in your face, then using Prozac is like putting a door between you and the shouting. The shouting is still going on, but it’s happening next door,” she says. “Prozac enables you to get out of bed in the morning, while CBT gives you the tools to use against your thoughts. It doesn’t cure you, but it gives you insight into how your thoughts work. With OCD, you can reclaim territory by putting yourself into your fears.”

It wasn’t until her fears, endlessly assuaged by Chris, went into post-natal orbit that she actually found out what she was suffering from. Until she had her baby, Joanne had arranged her life so that she could use avoidance as a tool. Rather than cause the unbearable feeling, she would avoid it by avoiding the things that caused it, by not going out, or using public transport, or putting herself in situations that would overwhelm her with anxiety. Motherhood shoved her irrational anxieties squarely in her face.

“I didn’t realise I had OCD until after my son was born,” she says. “I was troubled by harm anxieties — either my failure to prevent harm or my perpetrating it. I was too scared to talk to anyone about it in case my son was taken away from me. Then by chance I came across a tiny paragraph in a research book about how new mothers with OCD can often be full of fear that they will harm their child — it’s like normal new mother anxiety, but with a greatly enlarged sense of vulnerability to harm and an exaggerated sense of responsibility. It’s probably worse for women with OCD who have become parents because of the huge amount of cultural baggage around being a ‘good’ or ‘bad’ mother.

“So I went to the doctor, read up on the condition, and realised that this was what I had. All my life it had been this weird senseless thing that I had no context for. And at last I knew what it was.”

The author of two poetry collections, her memoir is interspersed with her poems, psychological theory and explorations on other anxiety disorders. As she says herself, she has read a lot of books with ‘brain’ in the title. She explains how OCD is caused by ‘brain lock’, where a normal thought process — saucepan-hot-ouch! — fails to turn itself off. Roughly speaking, this is caused by signal failure in the brain between the basal ganglia and the orbito-frontal cortex. Ever the poet, Limburgh describes the cortex of a plastic brain lent to her by a neuroscientist friend as “sculpted from petrified blancmange”.

So is OCD an illness of the mind, or of the brain? Is it psychological or physiological? “OCD is a mental illness, an illness of the mind,” she writes. “I do not now how the mind and the brain are related, and neither does anyone else. Let’s leave it at that,”

Meanwhile, now that she knows what she suffers from, and now that her son is seven and no longer a baby, and she remains happily married to Chris, how does her disorder affect her daily life?

“I still hate travelling, and have still never been on a plane by myself,” she says. “Only this year, I got on a train with my son without another adult present. I can’t drive, and I live in Cambridge, which is a bicycle town, but I am afraid to cycle. So when my son needs to go to swimming lessons, we take a taxi — I’m determined not to let my OCD interfere with his life too much.

“I can identify OCD thoughts and accept my limitations — with OCD and many other mental health problems, it’s about acceptance and management rather than cure. That way you can save yourself a lot of pain beating yourself up, and instead you can focus on working through it.”

The Woman Who Thought Too Much by Joanne Limburgh is published in paperback by Atlantic on January 6. £8.99

WHAT IF ...?

IN her early 20s, while a student at Cambridge, Joanne went on a cycling holiday in Ireland. Leaving Dingle one morning, pushing her bicycle towards the Connor Pass, she didn’t look where she was going and bumped into a ladder.

“There was a red furious face at the top of it, shouting something I couldn’t understand. I muttered sorry and walked on in tears, shocked and thoroughly ashamed of myself.

“That was all that happened. But if I had hit the ladder harder, the man would have fallen off, perhaps to his death — or he might have broken his back at the very least and never been able to walk again. The whole town would converge on me, shouting. I would be taken into custody and charged with… reckless walking with a bicycle? I would become a hated figure in Ireland, a selfish English student tourist bringing back bitter memories of colonial oppression by her cavalier maiming of a good, hard-working Irishman. They would all push for the maximum penalty. At the very least, I would never be allowed back into Ireland again.”