The obsessive thoughts of OCD are different to those that tend to dominate other types of mental anguish. Recurring and distressing thoughts are not always an obsession – at least not in the clinical sense. We can find our minds dominated by exaggerated and distressing thoughts of whether our child will survive and flourish in the world, for instance, or crippling nerves before an exam or driving test, but thoughts like that are in step with the rules and rhythms of our life. We want our child to be happy. We want to pass. We can think and worry non-stop about whether we might lose our job, but only because we know we need the money it brings to feed and clothe our family, which we feel and instinctively sense is the right thing to do.
Thoughts like that are ‘ego-syntonic’. They are in harmony with our drives and motivations. Ego-syntonic thoughts can make us unhappy, but when they do it is their contents and not the thoughts themselves that are the problem. We do not question why we have them. Indeed, sometimes we resent others who do not have ego-syntonic thoughts as acutely as we do. ‘I can’t believe you left this to the last minute.’ ‘It’s only been a month. Of course I still miss him.’
Taken to extremes these types of ego-syntonic thoughts can cause mental disorder, usually anxiety. But at their heart most concerns of anxiety are rational. So, usually, are the dark thoughts of depression: endless rumination on external events, regret of decisions and how life has unfolded. Severe grief, hysteria even, is based on the rational sense of loss.
Unwanted and intrusive thoughts, the raw materials of obsession, are different. They are irrational. They strike a mental discord. They are ‘ego-dystonic’. They clash with how we see ourselves, and how we want others to see us. Just to think these thoughts is enough to make us question who we are. We are not dishonest, yet we could snatch the money from that open till so easily. We do not want to be the dreadful person who could think such terrible and ridiculous things. But most people are.
Winston Churchill, a one-time First Lord of the Admiralty, didn’t like to travel by ship because of the ego-dystonic urge he had to jump into the water. Churchill was a well-known depressive but these, and similar thoughts he had of jumping in front of trains (he liked to stand with a pillar between himself and the edge of the platform) do not appear to have been genuinely suicidal impulses. Talking once of how he hated to sleep in a bedroom with access to a balcony from which he felt the urge to jump, he told his doctor Charles Moran:
I don’t want to go out of the world at all in such moments. I’ve no desire to quit this world, but thoughts, desperate thoughts, come into my head.
As Churchill observed, to have intrusive thoughts is not a sign that someone wants to act on them. A disturbing thought of sex with a child does not make someone a pedophile, just as an unwanted urge to hit someone with a hammer does not make someone a thug or a murderer. In fact the opposite is true. To consider such a thought or urge unwanted, disturbing and unwelcome – and so intrusive − is usually enough to show it is ego-dystonic and so contrary to someone’s normal personality and actions.
Where do these bizarre thoughts come from? The simple, if unsatisfying, answer is that we don’t know for sure. The theory used by psychologists who study OCD is that our brains have something they call a cognitive ‘idea generator’. On most other occasions, this generator helps us to solve problems.
To consider all possible solutions, it’s important for the mind to generate novel ideas and not immediately censor them. It’s a similar principle to a corporate brainstorm exercise and how every idea to boost sales or attract customers – however stupid – gets written on its own sticky note and given a nod of approval from an overenthusiastic manager. The cognitive idea generator does not have to anchor its responses to reality. Intrusive thoughts are what happens when the mind says ‘yes, and’ rather than ‘yes, but’.
Not all unasked-for thoughts are unwanted or unpleasant, far from it. Mozart revelled in musical thoughts he did not command. Beethoven said something similar:
You will ask me where I get my ideas. That I cannot say with certainty. They come unbidden, indirectly, directly. I could grasp them with my hands; in the midst of nature, in the woods, on walks, in the silence of the night, in the early morning, inspired by moods that translate themselves into words for the poet and into tones for me, that sound, surge, roar, until at last they stand before me as notes.
Random inspirations of musical genius are all very well, if you’re fortunate enough to have them. But the thoughts most likely to make the rest of us sit up and take notice are odd and unpleasant. Those are also the ones that tend to stick around. Nobody gets obsessed by thoughts that they will be too nice to people, or by urges to give all their money away to a tramp. People do not complain to psychologists of intrusive thoughts of pushing someone with the build of a heavyweight boxer under a subway train. Intrusive thoughts bother us because the usual imagined victims are the small and the weak, the puny and the vulnerable; the child and the little old lady. It’s what psychologists label the Arnold Schwarzenegger effect.
This might make sense, given the theory that a mental idea generator helps us to navigate through life. We may consider it uncivilized, but there are some situations where a natural and useful reaction when one sees a stranger would indeed be to beat them over the head. The smaller the stranger is than you, and so the lower the chance that they can hurt you, the more attractive that option becomes.
According to the theory, sometimes an external cue – the rattle of a train or a dirty floor – can kick the idea generator into action, and make it churn out intrusive thoughts. At other times the trigger is internal – the result of stress or a low mood or a subconscious emotional shift, or the residue of an incomplete memory. In this case, the intrusions appear almost at random.
It’s hard to test these ideas, so there is no experimental evidence to support them. All we know for sure is that intrusive thoughts pop up more in certain circumstances than others, under stress for instance, and that when they do appear, how we react is critical. A natural reaction, especially if the thoughts will not recede by themselves, is to try to force them to go away, to squash the idea, to deliberately shove the unpleasant notion behind the mental furniture or under the rug. That’s a bad idea. That’s when the problems can begin.
Leo Tolstoy knew well the mind’s inability to repel unwanted thoughts. When he was a child, the Russian novelist would play a game with his siblings. To join a secret club called the Ant Brothers, whose members would discover wonderful things, they had only to stand in one corner of a room and try to not think of a polar bear. As hard as they tried, Tolstoy and the others could not manage it.
Fyodor Dostoyevsky, a contemporary of Tolstoy, knew of the bear conundrum too. In his 1863 book "Winter Notes on Summer Impressions" he wrote: ‘Try and set yourself the task not to think of a white bear, and the cursed thing comes to mind every minute.’ A century later, that Dostoyevsky quote appeared in an article in the U.S. magazine Playboy, where it was read by a university psychology student called Daniel Wegner.
Wegner, who died of motor neurone disease in July 2013 just as I was finishing this book, rose to run the Mental Control Laboratory at Harvard University, but he will always be remembered as the white bear guy. His work with the bears can explain why, even though we see a hole in the road ahead, we steer our bike right into it. It shows why forbidden love offers the most thrills. It can reveal why soccer players, desperate not to hit penalty kicks straight at the goalkeeper, go ahead and do just that. In 2009, he wrote an article for the prestigious journal Science titled ‘How to Think, Say, or Do Precisely the Worst Thing for Any Occasion’. Most of all, Wegner’s research shows why unwanted intrusive thoughts can hang around; why some people find them so difficult to brush off. It shows how we can turn them into obsessions.
In the 1980s at Trinity University in San Antonio, Texas, just a quick gallop from the Alamo and one of the last places on Earth that anyone would associate with a polar bear, Wegner asked some of his students to repeat the Tolstoy trial under scientific conditions. He asked them to try to not think of a white bear.
Students told not to think of the bears found it difficult. And students told to do the opposite and to encourage thoughts of white bears, of course, thought of more. (Wegner kept track by asking them to ring a bell.) Most surprising was what happened next, when Wegner reversed the tasks so those students previously told to think of the bears were now asked not to, and vice versa. Those students who had originally tried to keep away the white bears now found their minds flooded with them – more so than the students instructed to think about them originally.
It’s an experiment that has been repeated many times since with similar results. It is hard, if not impossible, to suppress unwanted thoughts. And to try leads to an increase in the thoughts later on, after someone has stopped attempting to suppress them. The latter effect appears in psychology textbooks as the rebound effect of thought suppression. Most psychologists call it the white bear effect – try to make an unwanted thought go away and it will bounce back, harder and stronger than before.
Anyone who, to borrow a phrase from Oscar Wilde, can resist everything except temptation – who has tried to give up cigarettes, or to stick to a calorie-controlled diet – will recognize just how hard thought suppression is. That feeling, the urge and craving, is the sound of the white bear as it paws at the door.
This ironic effect – that a suppressed thought comes back stronger – could underpin a range of unusual human behaviors. It could explain, for instance, why those smokers who are the most motivated to quit also seem to find it the hardest to give up. The brain could interpret intrusive thoughts about a substance as a craving for it. The more smokers try to push away the thoughts of a cigarette, the more they amplify their craving. Studies show those people who had tried and failed to quit cigarettes are indeed more likely to suppress thoughts. A similar effect has been seen in obese people who overeat: they are more likely to suppress thoughts about chocolate and chips, and so increase the craving for them. Suppressing a thought before sleep can even make it resurface in a dream.
What’s going on? According to theories of how the mind works, the white bear effect is down to two mental processes. First, people who try not to think of the white bear must choose to think of something else, and so they introduce and employ a conscious distraction: thinking about what they had for breakfast, for instance. But before we can introduce a distraction, we must know there is a target to distract ourselves from. So, before we can suppress a thought, we must scan our conscious mind to see if it is there. And to do this, we must think of what we want to look for – the white bear – which is the target that we don’t want to think of.
Second, a separate process begins to make sure that the target, the unwanted thought of a white bear, is not present. While this second, monitoring, task is automatic, an unconscious routine that takes little work, the same is not true for the distraction, the thought suppression. That takes real effort, and so cannot last. If the monitoring process lingers after the distraction process has ended, and psychologists think it does, then our minds will continue to search for it. And this means we will find the unwanted thought more frequently than if we had never tried to suppress it in the first place.
That’s not to say that intrusive thoughts can’t be banished, at least in the short term. Distraction – to keep the mind busy – is a pretty effective way to do that. But it’s difficult to keep up for too long. Markus Wasmeier could manage it for barely three minutes – just long enough for the German skier to write his name into the record books.
Excerpted from “The Man Who Couldn't Stop: OCD and the True Story of a Life Lost in Thought” by David Adam, published by Sarah Crichton Books, an imprint of Farrar, Straus and Giroux, LLC. Copyright © 2014 by David Adam All rights reserved.