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Obsessive-Compulsive Disorder: Living Like a Tortured Poet

A new movie based on a novel by John Green has a new twist on OCD.

Key points

  • Few treatments for OCD focus on its existential heart: a fear of death and loss.
  • Talk therapy and exposure-response prevention can be used in conjunction for a more powerful OCD treatment.
  • John Green's "Turtles All the Way Down" realistically Illustrates the existential heart of OCD.
Source: Ed Gregory / Stokpic
Source: Ed Gregory / Stokpic

If you have obsessive-compulsive disorder (OCD), you tune into the world at a different frequency. You wonder which doors are clean enough to touch, which thoughts are pure enough to think, when your loved ones might die, or whether you’re truly in control. It’s like being tuned into an existential radio station all the time, with no pop music to offer a break.

Author John Green gets how exhausting this is. A sufferer himself, Green crafted the novel that the soon-to-be-released movie "Turtles All the Way Down" is based on to showcase OCD’s characteristic thought spirals and the methodically masterful ways it wears down its main inhabitants and robs them of their agency. The relentless question—to be or not be—constantly buzzes in the OCD sufferer’s ear, a fly always just out of reach.

Exposure-response prevention, the most celebrated and effective treatment for OCD, teaches clients to notice the fly but never to grasp at it. Buzz all it wants, it’s irrelevant, "full of sound and fury signifying nothing."

OCD is a nuisance to be rid of, not exalted. As an OCD advocate, Green wants us to feel that. And, yet, his characters tell another story, centering OCD around a beating and bleeding human heart, a profound sensitivity hardly ever discussed.

Clients from around the world who "fail" OCD treatment call and write to me that they aren’t encouraged to talk—even with their own therapists—about this heart of OCD. To attribute any meaning to OCD, they’ve been taught, is to enable reassurance. To envision OCD as anything other than a bio-behavioral glitch is dangerous and foolish. "It takes 17 years on average to arrive at appropriate treatment. Why would you jeopardize that?" say their therapists.

But what if clients really need to tell the fuller story of this sensitive heart? What is it like to live each day like a tortured poet?

That’s exactly what Green does. Teenage protagonist Aza Holmes is haunted by the sudden death of her father from an unexpected heart attack, and OCD jumps in to protect her from overwhelming fears over the precariousness of life. Is Aza really just a fictional character without any volition of her own? Is the bacterial microbiome that makes up 50 percent of the human body in true control of her? Aza constantly digs her thumbnail into her middle finger to see if she really exists. But no sooner she is found, she is lost again, spiraling about the possible infection she’s now unleashed.

Aza’s OCD finds an ingenious way of expressing her existential dilemma. Her scab is a brilliant metaphor of the ever-present wound of her father’s death and all our deaths. A broken heart—not a worried mind—is at the center of OCD. Or, as Aza puts it:

“When you lose someone, you realize you’ll lose everyone. And once you know, you can never forget it.”

There’s that existential radio station again, only it’s got as much feeling and fun as any Taylor Swift break-up song. You just need support putting it into words; that special frequency is so often misunderstood by those who don’t hear it.

This is exactly what you’ll find in Aza Holmes, just another in a long line of misunderstood heroines whose society has failed to nurture their true gifts. Happily, Green has given her and us a new way forward.

More from Michael Alcee Ph.D.
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