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“I want y’all to walk to the sign that represents the kind of OCD you most identify with,” announces the moderator, a young woman named Angie Bello who sits cross-legged on the carpet and whose service doodle, Sully, has docked his submarine snout in her lap. Around the room, volunteers hoist placards that say things like violent harm ocd, sexuality ocd, and contamination ocd. They smile benignly, and for an instant all one hundred of us—people ranging from twenty to seventy, joined by nothing but a particular kind of madness—stand frozen, a forest of amygdalas flaring. Outside, San Francisco at dusk: Bob Ross clouds in haphazard sweepings of pink and feathered gray and, darkening beneath them, the city itself, garishly beautiful and troubled.
We are in an upstairs conference room at the Marriott Marquis, a fortress of cleanliness and order acceptable even to the most afflicted among us. This is the icebreaker on the first full day of the twenty-eighth Annual OCD Conference in July 2023, a global summit marshaling together hundreds with the illness and, alongside them, therapists who treat it and researchers who endeavor to grasp it. OCD, which swarms people with distressing thoughts and drives them to seek relief in life-consuming rituals, is an isolating and often secret condition; it is not, generally speaking, a thing one puts in a Hinge profile or drops over daiquiris. But this weekend, we are repeatedly reminded, is about “shattering the stigma.” It is also the first full-blown OCD Conference since COVID-19, and because that calamity hit many in this crowd with especial force—because, as one man will tell me, “everything we’d always feared was finally happening”—it feels historic.
I walk to contamination ocd, passing several goggle-eyed souls clustered tensely beneath violent harm. I’m late arriving: a sweet, spectacled computer programmer is describing his phobias of rabies and AIDS. “If I spot markings on anything in my apartment—groceries, furniture—my brain decides they’re bite marks, like by a bat, and even if I just bought it I have to toss it.” Everyone nods; encouraged, he goes on. “Sometimes I think about how recent all this is. Like, humans haven’t even known about germs for that long!”
Kellie, a slender woman of twenty-four, chimes in: “I sometimes feel like my various forms of OCD are at war. My contamination OCD forces me to shower, but then showering triggers my BDD.” Body dysmorphic disorder, sometimes thought to be a form of OCD, torments people with an illusion of physical defects. So, as a teen, Kellie became convinced something was wrong with her face—invisible to everyone else but to her as incontrovertible as the blueness of the sky. She would miss school, mesmerized by the bathroom mirror; believing she looked “subhuman” and plagued, too, by contamination dread, she took to drinking peroxide. At last, suicidal, Kellie checked into McLean Hospital in Massachusetts, undergoing exposure and response prevention therapy (ERP), the gold standard in OCD treatment, whereby patients incrementally confront the source of their fear and are barred from performing their rituals. Clinicians took photos of her, blew them up, and hung them from the walls of the kitchen for all to see while they ate, alongside signed declarations by other patients attesting to their intrusive thoughts (things like “I want to do a dog. Sincerely, James Lee”). It worked: she wrested control of her life, moved to San Francisco, and, belatedly, enrolled in college.
“How’s yours manifest?” someone asks. All are peering at me. “Breath stuff,” I say coolly. “Airborne contamination stuff through my mouth, my eyes. Identity stuff.” Since I was a boy, I have suffered from a kind of OCD driven, at bottom, by what I once described to a therapist as a “fear of self-loss.” There were people in my childhood orbit whose volatility gave life the feel of being perched on a tectonic rift. I grew afraid of becoming them—avoided looking at their pictures so I wouldn’t absorb their essence, held my breath when they walked by, frightened of inhaling their wake. In time the scope of my fear widened to encompass more and more people whom I deemed monstrous. I became a kind of anti-Proteus, hell-bent on safeguarding my self. By nine I’d devised a private religion, with strange mantras and rules so severe that Calvin would have dismissed them as fucked up. Having done something objectionable, I went off in secret to repeat “Scratch that from the record” over and over, and apologized to God.
“Time!” Bello’s voice rings out, astonishing the room. “You were all so vulnerable just now. Give yourselves a pat on the back for being vulnerable.” I look about me at wizened adults with, I imagine, paid-off mortgages, wills, and Roth IRAs, reluctantly tapping their deltoids. Preschool directives aside, the icebreaker triumphs: suffusing the room is an aura of defiance, of people lately emerged from a bomb shelter, dusting themselves off and looking gamely at a world that for two years confirmed their catastrophizing, where every rando, confronted with contagion, became an amateur Howard Hughes, a devotee of DoorDash and pumper of Purell.
Every kind of OCD sufferer is here: a new mother haunted by thoughts of killing her baby, who wonders through tears what to make of it all; a man who for years jumped on his bed hundreds of times before getting in, who’s incinerated months of his life alone in obscure rooms, spinning about suddenly in an effort to catch a lurker behind him; mild men like me, thoroughgoing Jekylls, racked by thoughts they’ll morph into Hydes, turn terrorist or Kia-jacker or #MeToo-able groper. We are all object lessons in the brain’s ungovernable will, its impishness, its refusal to be yoked to the ends to which we have put it.
When, at the close of the session, we reconvene in a single large circle, Bello asks us to take turns saying something we’re grateful for, which prompts a groundswell of confession and catharsis worthy of a revival meeting. “I’m grateful,” one man says, “for my diagnosis after forty years of suffering.” A young woman: “I’m grateful for the one weekend in the year when I don’t feel like a nutjob.” “I’m grateful,” I say, “for good health, and music, which has always been an escape from OCD.” This impresses no one particularly, and when the session ends we scatter and I shuffle downstairs to the atrium and cash bar, where hundreds have gathered for the welcome party.
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