We've become a culture that prides itself on excessive behavior. We boast of being "totally OCD" about how we arrange our desks, we humblebrag that we check our social media feeds "addictively." And in a world of such overload, it's hard to tell what truly constitutes overdoing it. Science writer Sharon Begley is here to help. In her new book "Can't. Just. Stop: An Investigation of Compulsions," she examines the compulsive mind — and she separates disorders from impulses, anxieties from addictions. It's a fascinating history and exploration of a particular bent in the human psyche, and how it can manifest in everything from video-game playing to hoarding. Salon spoke recently to Begley about how technology plays with our brains, and the upsides of anxiety.
This is not just a book about a single kind of mental disorder. Tell us what the impetus for exploring compulsion was.
I looked around at my friends, my colleagues and the world in general and was seeing that a lot of us are engaged in one or another compulsive behavior. I’m not surprised, given the industry where I work. A lot of us deal with compulsions. None of us can go anywhere without our phones any more. It wasn’t just the ubiquity of that behavior but it was a suspicion about what underlies it — that we don’t love it. It’s not that it’s making us joyful and satisfied or excited or it instills positive emotions. But it all has to do with avoiding the negative function.
When you’re a reporter and you can’t go to the bathroom without your phone, it’s not because you love your phone. It’s because you’re terrified that you’re going to miss something. That little germ of an insight made me look at other compulsions. It turns out that so many of them indeed are also driven not by, “Well, I love this. This is really making me feel good,” but by “Oh my God, if I don’t do this, I’m going to feel totally horrible.”
It was really interesting for me when I began to understand OCD as an anxiety disorder.
When I started this, I was on the fence about including an OCD chapter partly because I thought that it might be more insightful to look at the compulsions that are not recognized as mental disorders. Of course, so much has been written about OCD. But then as I got into the research, it was clear that OCD provided many insights psychologists and psychiatrists have, and that could be the jumping-off point for a lot of discussion about other stuff. I’m glad I included it, but I still think that it should not overshadow everything else just because it's the one compulsion that I think most people are familiar with.
You also demonstrate two of the points that are really crucial to your book and make it really special. One is establishing the distinction in our very often fluid conversation between compulsion and addiction: what those both are and how those things really boil down. And you really do keep coming back again and again and again to the fact that with compulsive behaviors, people don’t do them because they make them feel good; they do them because it’s about responding to fear and anxiety. I use the same analogy when I talk about medication, and people who take antidepressants. They’re not taking them because it makes them feel great. They’re taking them because it makes them feel not as bad.
Yeah. They're just getting you up to the baseline of zero. Getting into positive territory is a wish that we all look for but it’s just really, really tough. So many of us are just settling for, just please get me out of negative territory.
The other point that you make throughout the book is that concept you hear people say: “We’re all a little mentally ill. We all have a little bit of mental illness.” You talk about the fact that compulsion and compulsive behaviors are very prevalent but you flip it. That doesn’t mean that we’re all mentally ill because it doesn’t mean that all compulsive behavior is mentally-ill behavior.
Exactly. I think that was a consequence of covering psychology and psychiatry for a few years and just listening to the conversation and the debate. So many of the things that psychiatrists are really, really quick to try to find the diagnosis on are just, I think, somewhere along the spectrum of human behavior and human quirks and not necessarily mental disorders.
As you point out in the book, there is an ancestral and genetic reason for us to have anxieties and for us to have fears. There is an argument to be made that those are the kinds of genes that get successfully passed down because people who have that enhanced ability to sense danger or to be aware of danger are more likely to survive.
Absolutely. Those who didn’t get an adrenaline rush and a sense of fear and anxiety when they heard twigs cracking did not survive to be our ancestors. There’s absolutely an evolutionary case for why anxiety is adaptive.
I think one reason why we’re seeing so much compulsive behavior now is emblematic of this age. Of course, I wrote this book before Jan. 20, before Nov. 8. When you are living in the time that we are, it really makes sense that people go to any kind of behavior or way of thinking that can drain away just enough of that anxiety so that they can operate.
It’s hard to not feel anxiety. It’s hard to manage our own level of participation in it. How do we have any measure of control? Sometimes the only measure of control one has is to compulsively keep refreshing the New York Times page.
Talking about this now, many things in the book were not in my original plan but in retrospect I’m glad they're there. There are some benefits to anxiety that are helpful to the individual and the world. We do what we can. There’s only one Steve Bannon or Paul Ryan, and those of us who are mostly on the sidelines are motivated by anxiety to go out and do something. Let’s be appreciative of what anxiety can push us to do.
You’re bringing up the point of anxiety as an agent for good and compulsiveness as an agent for good as well. Certainly it bears mentioning that these impulses can be part of a brain that is reaching to make things good.
For many of us, even in these milder forms, it’s a reaction and it’s a way of trying to make order and sense of things and trying to make them good and just also trying to alleviate anxiety.
Because this is such a fluid and plastic concept, how does one really know when something is a disorder and when it’s just your basic, run of the mill, modern life compulsive behavior?
One of the many difficulties that psychiatry has is that it has no blood test. At the end of the day, there’s a huge amount of subjectivity involved. However, the basic answer is, in order for something to be a mental disorder, it has to cause either distress or impairment. It has to impair your ability to function in the world, which means relationships, school, job, wherever you are in your mind. It has to cause distress, which again is a subjective thing. So if instead the behavior is helping you and not causing distress or impairment, then you'd really better think twice before labeling it a mental disorder. In the case of OCD, it tends to be impairing if you have to keep running back to your house to see if you locked the front door or go to the restroom 50 times a day to wash your hands. I would say psychiatry has a way to go before it can figure out how to make accurate, objective diagnoses.
We seem to have — not just with anxiety disorders, because we certainly seem to do it with addictions — a kind of “Aw, isn’t that cute?” attitude around certain mental disorders. What do you think about this primal attraction or inability to see the line between normal or interesting eccentric and, “Oh, this is actually disordered behavior?”
I’ve observed the same thing, like that show "Monk." That was portrayed exactly as you said: romanticized with a little bit play for humor. But the message was, this is cute and eccentric and it makes him more interesting. Of course, the way hoarders are depicted on some of the cable shows, that’s less sympathetic in its portrayal, but there's just an inability to perceive that so much is really, really about suffering or struggling. I don’t know why we tend to romanticize some of these things, because the the flip side, of course, is the stigma of mental illness. Could it be that we don’t want to recognize when people are suffering because then that might make us think that — especially if it’s someone we’re close to — then I have an obligation to try to help? It’s just easier to say, “Oh, charming, cute, interesting, whatever.” Honestly, it’s a puzzle. There is nothing fun or charming or cute about it. For people who are really suffering, they are suffering.
Why do you think it feels like we are a more compulsive culture than ever before?
One of the reasons, I think, is technology. Because the digital stuff that we now have is set up, especially in terms of its reward structure, to tap into the part of our brain that can’t resist acting compulsively. But just because you have a compulsive behavior doesn’t mean that your brain is broken. Instead, if it’s social media or tweeting or email or checking, texting and all the other things, it’s because these things have a structure that exploits the way our brains work.
The important phrase that really struck me is the concept of intermittent reward, and how seductive that is.
Also, just so many of us cannot stand to be alone with our own thoughts that we have that crutch so that we don’t have to think. A reporter interviewed me last week asking something about why people, when they’re out on social occasions — dinner parties, dinner with friends, bar, or whatever — have their faces always attached to their screen. That is a lot easier to do and that drives away anxiety from what would otherwise be an anxiety-provoking social situation. The reason I think so many of us are acting compulsively is the technology. It just exploits something that we all have within us.