36DSM-IV 300.30 
Mikita Brottman 
 
1.  When were you first diagnosed with obsessive-compulsive disorder?
 
     I didn't see a psychiatrist until I was about eighteen, but I've had my “thing” ever since I can remember. I never thought it the least bit unusual; in fact, I think a lot of people have a “thing.” My “thing” was that I had to touch certain objects an even number of times in order to “even things out.” For example, if I accidentally knocked my hand against the side of a piece of furniture, I had to do it again, to make sure that I'd done it twice. Sometimes, if I wanted to be very safe, I'd do it three more times, so I'd done it four times altogether. It had to be an even number. I've always felt funny about odd numbers. They feel sort of unfinished to me, like a piece of music with the last note missing.
     I call it a “thing” because once I saw my sister touching the wall deliberately with her hand the same way I did, and I asked her what she was doing.
      “It's just one of those 'things,'” she said. “I have to do everything on both sides. Don't you have a 'thing'?”
      Until then, I'd thought I was the only person with a “thing,” but after talking to my sister I decided that everybody must have one. My sister's “thing,” it seemed, was similar to mine, except instead of repeating gestures like I did, she had to counterbalance them by doing them on the opposite side. So if she accidentally knocked her right hand against something, she then had to touch the same object again with her left hand. It was just like my “thing,” only I think my sister's might have been worse than mine, because I saw her doing it a lot.
      Later, I discovered that not everybody has a “thing,” but I think they're pretty common. If you have a “thing” yourself, you always notice when somebody else has one. I have a friend whose “thing” is the opposite of mine; he can't stand even numbers, and he always has to do everything three times.
        When I first told a psychiatrist about my “thing,” he said it stood for my desire to be in control. He called it “a talisman to ward off contingency.” If I did something by accident, he explained, it felt as though I weren’t really in control.  But if I went back and repeated the gesture deliberately, it meant that the first time hadn't really been an accident at all. He told me that my fear of odd numbers was a fear of things being “open” and not “closed off.” He said I appeared to be anxious about anything that wasn't  ordered or categorized, anything that hadn't been “put away in its proper place,” as he put it.
      Later, as I grew older, my “thing” seemed to change and take on other forms. I went through a stage when I was about eleven when I couldn't stand open doors. I couldn't bear to be in a room if the door was open, even just a tiny little crack, even if it hadn't been pushed completely closed. Whenever anybody came in or out of a room and didn't close the door properly, I had to get up from whatever I was doing and push it to.
       When I was about fifteen, I went through a stage of being unable to read anything that was written by anyone who didn't close the loops on their o’s and p’s, or didn't dot their i’s. I had to pick up a pen and go over what they'd written, closing their letters and adding the dots. I always had to go back over everything I'd written to make sure the loops on my letters were closed firmly. At school, I got the reputation of being a slow reader because I had to check the page numbers of the book I was reading, just to make sure they were in the right order. Sometimes I had to read certain pages two or three times, to be certain I hadn't missed anything.
      A year or so later, I remember going through a stage when I couldn't be completely comfortable if I hadn't just been to the toilet, even if I didn't need to go at all. I used to go to the toilet all the time, especially if I was about to go out of the house, or if I was settling down to do anything that would take more than an hour or so. I had to make sure I wouldn't be interrupted by needing to go in the middle. I'd often go four or five times before a show I wanted to watch on television. I'd also go during the commercials, just to make sure. Most of the time, nothing came out except a pitiful little trickle, but still, I had to go just the same. Noticing that I was going to the bathroom with unusual frequency, my mother took me to the doctor where they did some tests on my blood sugar, suspecting I might be diabetic.  But according to the tests, everything was as it should be.
       As I grew older, I thought less about my “thing” and never asked my sister about hers, though I'd sometimes catch her doing it from time to time. It wasn't as though my “thing” ever disappeared, though.  It was more as if it grew with me and mutated into an ever–changing series of different “things,” strange obsessions that possessed me from time to time, none of which seemed far enough removed from ordinary teenage behavior to seem particularly strange. For example, when I started to get serious about reading and writing–when I realized I wanted to go to college–I made up a series of superstitions to help me study. If I started having anxious thoughts about failing my exams, I'd have to hold my breath for ten seconds to counteract their negative influence. If I got less than a B on a paper, I'd have to go to sleep with my books open, so I could absorb the material through osmosis, in my dreams. Every morning, I'd submerge my face in scalding water for thirty seconds, convinced this would drive out whatever demon it was that caused my skin to glow with burning lumps of acne, a ritual that seemed more and more inadequate every day. Looking at my face each morning in the bathroom mirror, I'd be greeted by some horrifying new cluster of swollen pimples that seemed to have cropped up in the night just to mock me and my crazy routines.
 
2.  Do you ever find yourself obsessing about dirt and germs?
 
       I've never had to wash my hands or shower compulsively, though I've always been very tidy. I feel uncomfortable in places that are cluttered. I don't like eating in restaurants that look dirty, and I don't like using public toilets.  But who does? I can't drink out of containers that somebody else has just had their mouth on, and I can't eat from someone else's spoon; but that's just ordinary hygiene.
      In some ways, in fact, I'm quite the opposite of fussy. I don't mind buying clothes from thrift stores–except underwear of course–although when I shared a bedroom with my sister, we also used to share our underwear. If I'm invited to dinner at somebody's house and I notice their kitchen is dirty, I can still manage to finish my meal. I let my cat sleep in my bed with me, and sometimes I even let him lick from my ice-cream carton, with I'm sure is about as unhygienic as you can get.
      Of course, cleanliness is important, but you can't take these things too seriously, or it would drive you completely over the edge. After all, if you think about it, we're  surrounded by dirt and germs all the time. Even the most spotless homes are full of dust mites, and there are spiders living under everybody's furniture and in every crack in every wall. Our bodies are teeming with germs and bacteria, especially our mouths. Have you ever looked at human saliva under a microscope? And have you ever wondered what really happens to food when you put it in your mouth, and what happens to it inside your body? Just imagine, all that stuff being mashed up and mixed together, all that meat and vegetables rotting in your intestines. If you think about it, the whole process of eating and digestion is completely disgusting, but you have to try not to think about it. If you thought about things like that all the time, you'd never be able to eat anything again.
      I keep my own apartment clean, and that's all. The hallway and staircase in my building are often dirty, but I try not to worry about that. You can't clean everywhere. I'm a professor now, and I lead a busy life. I don't have time to clean every day. Sometimes I'll go three or four weeks without cleaning.
      Still, when I clean, I really go all the way. It will usually be some little trigger that sets me off unexpectedly–orange juice stains in the refrigerator, or hair plugging up the bathroom sink–and then there'll be no stopping me; I'll go to war. I'll climb into my overalls, tie back my hair with a duster, and gather together my army of mops, bleach, squeegees and disinfectant sprays. Then I'll go to work on the entire apartment, from top to bottom, scrubbing the kitchen floor, scouring the oven and sweeping the deck. And it won't stop there.  I'll disinfect the trashcans, de-scale the coffeemaker, and clean all the windows, inside and out. I'll re-pot the plants, re-align the pictures on the wall, move around the furniture, and sometimes even bathe the cat. Often, I'll go to work on my wardrobe as well, tossing out half my clothes and other things too–shoes, books, music I never listen to any more. Sometimes I don't stop until late at night, but I have to finish before I sleep; I can never go to bed at night with anything half-done. And the next morning, it's so wonderful to wake up to a fresh, clean, tidy, uncluttered apartment; it's one of the best feelings in the world.
      My office at work is always neat and tidy, too. I hate being surrounded by clutter. When I'm watching Cops and they show the shabby, dirty home of some thief or drug dealer, it makes me so twitchy and uncomfortable I want to switch off the television set and go and clean my kitchen. Sometimes I even have to shut my eyes until the scene is over. People with their heads cut off or their guts hanging out don't bother me at all, but show me a dirty counter top and I start to hyperventilate.
      I often wonder–when does an ordinary routine or a series of habits become a disorder? These things seem to happen very slowly, the way a person who has a couple of drinks after work every night gradually becomes a full-blown alcoholic. It takes years and years for things like this to develop. I know a girl with the cutest dimpled smile, but at the same time, I can tell it's a smile that is slowly on its way to revealing a small double chin. I have another friend whose unkempt looks attract all the girls, but I can see that the things that make him look so sexy today will one day make him look like a homeless person. These things happen slowly, the same way that the choices we make always become traps for us, in the end.
      I've always chosen to live on my own. Ever since I left home to go to college, I've always had my own apartment. Even when I've had steady, serious boyfriends, I've never moved in with them, because I'm very independent, and I've always treasured my freedom. Recently, however, I've started to realize that I'm probably no longer capable of living with another person, even if I really wanted to. I've become too set in may ways. And eventually, I know, the independence I consciously chose will become solitude, then loneliness, then total isolation. And the next thing I know I'll be one of those shut-ins whose corpses they find only after they've been lying alone for months, and the neighbors complain to the police about the smell.
 
3.  Have you ever engaged in self-mutilation (cutting, hair-pulling etc.)?
 
      I first started playing with my hair when I was studying in my bedroom at night. I used to have long, thick hair, and at first I used to just wind it around my fingers or chew on it while I was studying. Then I got into the habit of checking constantly for split ends, and, whenever I found them, pulling out the damaged hair by the root. There was something deeply satisfying about pulling out the individual hairs. I felt a little shudder of pleasure whenever I felt the bad strand being pulled tightly out of my scalp. I found myself doing it more and more often, even with hairs that weren't split. It was just a habit, almost unconscious. I think it might also have helped me to concentrate on my work. I also started tweaking the individual hairs out of my eyebrows with my fingernails, and pulling out the thin hairs on my arms and legs.
         At this time, I was hoping to take the Oxford entrance exam, and I was studying for at least six hours every night after school. Since I was spending so much time reading, it wasn't long before my hair-pulling started to get out of hand. At first I was aware only of the mess; there would be hairs all over my books, my desk, my bedroom floor. Then, after I'd started pulling the hair out in clumps, odd little bald patches began to appear clustered around my scalp. It looked very peculiar, but since I was only half-aware of what I was doing, it was very difficult for me to stop. When the bald patches started to get noticeable, I tried to limit myself to plucking my eyebrows, but soon I'd plucked them completely out, and went back to my hair again.  When people at school started making comments, I tried to make myself conscious of what I was doing, but before I knew it my fingers would be back in my hair again, plucking away. Sometimes, if I hadn't pulled my hair all day, I'd allow myself a small treat–five minutes of uninhibited hair-pulling before I went to bed.
      Eventually, my bald patches became obvious even to my mother, who made me an appointment with a psychiatrist–a gray-haired old man who made me lie on a couch–who suggested that I find something else to do with my hands when I was reading, and gave me a puzzle-cube to play with. When that didn't work, he encouraged me to take up knitting, but that was no good because I couldn't knit and read at the same time. Finally, he came up with a complicated scheme whereby every time I found myself pulling my hair, I had to touch my left foot four times as “punishment.”  This worked very well because it keyed into my compulsive tendencies as well as my “thing,” which I'd already discussed with him.  And although I probably looked rather bizarre while I was doing it, it seemed to solve the problem very well. 
 
4.  Have you ever been diagnosed with an eating disorder?
 
      I've always been tall, with strong bones, a long body, and long, muscular arms and legs. With a body like mine, I always felt that I had to watch out for fat. I always felt that fat had its eye on me. Inside my normal-sized body, I often thought, there was a fat girl struggling desperately to get out. I felt as though I was on the verge of turning from strong and tall into “well-proportioned,” and from “well-proportioned” into “full-figured,” and then from “full-figured” into “hefty.” And as everyone knows, it's only one small step from “hefty” to just plain fat; and then the next thing you know, you're being hauled out of your Florida condo in a fork-lift truck live on Jerry Springer.
      I've always enjoyed my food; and when I was at school, I was far too self-conscious to go to a gym, so I had to find other ways of keeping my weight down. Almost all the girls I knew were able to make themselves vomit–we used to call it “consulting Dr. Fingers”–but I couldn't do it, no matter how hard I tried. Have you ever tried to make yourself puke? It's actually very difficult. I could never understand how everyone else seemed to manage it. My throat would ache, and my eyes would water; I never got the hang of it. I'd try to make myself throw up, fail miserably, and be in bed with a sore throat eating ice-cream for the next three days, which would make me feel even worse.
      And so I'd take laxatives instead–yes, the emetic of wimps. A handful of Ex-Lax before meals would quickly turn anything I ate into stringy, foul-smelling, light-colored threads of excrement–which, at least according to my biology textbook, was the exact appearance of the stools of a weasel. I felt kind of weaselly too, for taking them, but however disgusting my habit might have been, it worked to keep the weight off. At the time I was young and naïve enough to tell my psychiatrist about my laxative use, and ever since then I've been saddled with the burden of an “eating disorder,” which is utterly ridiculous, since if anything it's all about order, not disorder–about saving myself from the madness which would surely descend upon me if I were to give in to my body and give it what it wanted, which was to get fat. 
      Once I was put in a psychiatric hospital after suffering what they described as a “psychotic episode,” and the thing I resented most about being there was the food they made me eat. The meals were carefully planned, full of fruit and vegetables, but there was just so much food. When they saw from my records that I'd been diagnosed with an “eating disorder,” they insisted I finish everything on my tray. I couldn't believe how much I was expected to eat, every day. There was cereal, fruit and toast for breakfast, pasta and vegetables for lunch, meat and more vegetables for dinner, dessert with every meal, and a snack before bedtime. When I complained that there was far too much food for me to eat, the nurse explained that this was a balanced diet worked out by a qualified nutritionist, and it contained exactly the right amount of calories.
      “The right number of calories for what?” I asked. “To become morbidly obese?”
      “The right number to keep the average person in a good state of health.”
     “Well that's just the thing,” I tried to explain. “I'm not the average person. You wouldn't believe how easily I gain weight. For example, if I eat a quarter pounder, I actually put on more than two pounds.”
     “You'll need to finish all your meals before we let you out of here,” he replied, unsympathetically. And so I let them fill me full of drugs and move me from my bed to my food tray four times a day, like a veal calf being fattened up for the slaughter. They said I had to get back to my “normal bodyweight,” but nobody seemed to understand that my “normal bodyweight” was unattractive and unfashionable. I tried to explain that by forcing me to swell up like a battery chicken, they were actually running a grave risk to the stability of my mental health, but nobody seemed to see it that way. Every meal time they reminded me that I had to eat everything on my tray before they'd let me go. I doubted they had any right to hold me longer than the 72 hours specified in the emergency court order, but I ate what they gave me just in case.   
       And putting on a little weight didn't seem nearly as bad as being kept in a locked cell. I'd refused to admit myself voluntarily, so I'd been taken there in a police car, in handcuffs. Even worse, after I got out, they sent me an enormous bill, and at the top of the bill it said, “Thank you for Choosing Johnson County Hospital.”
 
5.  Have you ever seen a therapist on a regular basis?
 
      When I was first diagnosed, I started seeing a counselor, Christine, who worked at the psychiatric clinic. She was woman in her fifties who wore jeans, sandals, and tie-dyed T-shirts or rainbow-colored kaftans. I saw her more as a friend than a counselor. We chatted about our problems; I'd tell her about the trouble I was having with my Ph.D. coursework, and she'd complain to me about her mother, who had come to live with her after having a stroke. When Christine moved to Oregon, I made her a blue ceramic dog bowl in my pottery class. After that, I had a few other counselors, but I didn't like any of them as much as I'd liked Christine; and in the end I decided I didn't really need counseling any more. 
      Then one day I'd read an article in the New York Times Magazine about the psychiatric system, which said that everyone had the right to see their medical records, if they asked for them. The article said you just had to write a letter to your doctor and enclose the cost of photocopying, and you could ask for any documents you wanted, as long as they had your name on them. So I'd sent off for copies of my files from the clinic.
       I was shocked to see the notes Christine had made about our sessions. For example, the first time she'd met me, she'd written, “Patient appears emotionally immature, though looks much older than stated age.” What nerve! She was the one who dressed like a teenager, even though she must have been pushing sixty. She'd also written things like “Patient greeted me with superficial smile; continued to address me in inappropriately familiar manner.” I was mortified. Who was she to say my smile was “superficial”? How did she know I wasn't genuinely pleased to see her? Why hadn't she told me it was inappropriate for me to consider her a friend?
     Even worse, they sent me a copy of my records from the time I was hospitalized; there was my name at the top, and next to “Description,” somebody had written “thin, blonde, psychotic.”
 
6.  What medication are you currently taking?
 
      My first psychiatrist put me on a large daily dose of amitriptylene; this was before the days of Prozac, Zoloft, and all the other new drugs. The amitriptylene took a long time to get used to. I'd take it before going to bed at night, after I'd finished studying; and the next morning, at college, I'd be totally wiped out. Sometimes it would be quite impossible for me to get out of bed; I'd sleep into the middle of the afternoon. If I needed to get up for class, I'd be walking round like a zombie until lunch time. Sometimes I'd lock myself in a stall in the girls' bathroom, sit on the toilet and fall asleep, missing my morning classes. But after a month or so I started to get accustomed to it and stopped feeling tired all the time.
       When I got my first teaching position, I registered as a patient of a psychiatrist called Dr. Lincoln. One of the first things he did was to change my medication. I was down to 75mg of amitriptylene by this stage, but Dr. Lincoln brought it down even further, to 50mg, which, he said, was much easier for him to prescribe, since it was just one tablet, not the two I'd been taking before. Whenever I went to see him, he was always friendly and chatty, asking me how everything was going; but after my experience with Christine, all I wanted him to do was write my prescription and let me go.
     Then one day he glanced at my file, and asked me if I was still “depressed.”
      “I've never really been depressed,” I said.
     “Good. You're feeling better?” he asked, still looking through my file.
      “Just the same,” I said.
     Dr. Lincoln didn't seem to like this response. “You must be feeling better than when you first came in,” he said. “I see here we decided to decrease your medication. You're doing fine on the new dose?”
      “You decreased it because it was easier to prescribe,” I said. It was obvious that he had no idea who I was, and knew nothing about my history. He might as well have been looking at my file for the very first time.
     Dr. Lincoln made a triangle with his fingers, puckered his lips, and frowned at me, swiveling from side to side in his chair, as though considering something of great importance.
     “It's a lower dose,” he said, finally. “I wouldn't have prescribed a lower dose if I didn't think you were improving. You look much better than when you first came to see me, much less depressed. How are you doing in school?”
      If I hadn't been depressed before, I certainly felt depressed then. He'd glanced at my college address and assumed I was a student, not a professor. After that, I realized something that should have been obvious to me a long time ago:  most psychiatrists had so many patients that they couldn't possibly keep track of every individual they saw. As far as Dr. Lincoln was concerned, every time he saw me, it was as though he were seeing me for the first time.
       I didn't mind this at all. It was a busy clinic–I'm sure he had hundreds of patients – but what I really resented were his attempts to pretend that he knew who I was. He'd take a sneaky glance at my file, then say things like, “College still going well? Classes difficult?” or “Any more of those obsessive thoughts?” or “How's the new dosage working out?” It seemed so transparently hypocritical; I saw quite plainly that he had no memory of me, no idea of who I was, and no particular interest in my case.
      This came as something as a revelation to me–the idea that nobody was really looking out for me, nobody really cared. Around the same time, and partly, perhaps, as a result of this discovery, I decided to stop taking my medication. I knew there was nothing seriously wrong with me. It was certainly true that I had some peculiar character traits, and I could be rather compulsive at times, but that wasn't a disease that needed curing; it was just my character. I was older and calmer now; I was a Professor of English with an Oxford PhD. I knew I wasn't going to go back to pulling my hair out or going to the bathroom all the time. Yes, perhaps I was rather fastidious, perhaps I could be slightly fussy, but that was hardly unusual.
     And the truth was, I missed my compulsions.
    So I stopped taking my medication, and this helped me to learn some very interesting things about myself. For example, if I were writing an article for publication, I couldn't leave it unfinished–I had to keep working until I was happy with it, sometimes staying up three or four nights in a row until I felt it was finished. There was something exhilarating about this obsession with writing; I started publishing regularly, in increasingly prestigious journals. Sometimes, after a day of teaching, I'd spend all night working on an article and then go straight into class again the next morning. When I was full of inspiration and ideas like that, I hardly seemed to need any sleep at all. I started working out more frequently at the gym; I started teaching a seminar on Joseph Conrad in the evening. My appetite seemed to decrease dramatically; I felt taut, slim, energetic, and healthy. This, I thought, is what it really feels like to be me.
       It seemed ridiculous to me then, that my particular kind of personality had been “diagnosed” by a psychiatrist and given a specific number from a manual–in my case, 300.30. If my personality fit with a specific number in a manual, I thought, then so should everybody else's; there should be as many numbers in the manual as there are people on earth. I knew that obsessive compulsive disorder was one of the most common forms of mental illness, and I'd met plenty of other people who'd also been diagnosed with it–who shared my number from the manual–but none of them had been anything like me, even in their obsessions and compulsions.
      So I stopped taking my medication, stopped going to the clinic, and stopped seeing Dr. Lincoln. I didn't even bother canceling my next appointment, and nobody called to find out what was going on–not the nurse, not the receptionist, certainly not Dr. Lincoln. My file is probably still there in his cabinet drawer, gathering dust. After that, I had no more illusions about the mental health system. Psychiatrists don't really care about you–most of them don't even remember your name–and I felt foolish and naïve for assuming otherwise. The truth, I realized, is that you have to look out for yourself. As Marlowe tells the narrator in Joseph Conrad's Heart of Darkness, “we live as we dream: alone.”