Obsessive-Compulsive Spectrum Disorders
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by David Adam
Sarah Crichton, 2015
Review by Leo Uzych, J.D., M.P.H. on Nov 3rd 2015

The Man Who Couldn't Stop

The Man Who Couldn't Stop is a book about obsessive-compulsive disorder ("OCD").  The author, David Adam, is an editor and writer, at NATURE.  Adam reveals, in Chapter 1, that he obsesses about ways that he may catch Aids; and Adam states, with blunt candor, that he sees HIV everywhere.  Adam adds, in concluding Chapter 16, that he will probably always have OCD; and that, to him, HIV is no longer the reality of the disease and the virus, it has instead become a symbol of a lost life.  Readers will very likely be glued firmly in fascination to the pages of the book, as skilled intellectual pilot Adam, over the book's course, skillfully navigates a dual substantive path:  adeptly weaving a textual tapestry in part with biographical threads tethered anecdotally to Adam's life; while also displaying mastery of strands of clinical and medical research data tied to OCD.

Numerous, pithily encapsulated clinical case studies, joined to OCD, populate the text instructively.

Structurally following the text, there is a trifurcated "Notes and references" section:

In one part ("A note on sources"), Adam explains succinctly that most of the book's case studies are drawn from accounts published in medical and scientific reports, written by the doctors who treated the patients described and by the scientists who have researched their conditions.

In a second part, Adam gives some "Suggestions for further reading", germane substantively to the textual contents.

And thirdly, "References" are presented in this section, on a chapter by chapter basis, by textual page.  Citation data are connected, substantively, to textually embedded words or names.

Two appendices are placed structurally after the Notes and references section.

Snippets in the form of quotes culled from eclectically ranging sources didactically adorn the text's body in considerable number.

Readers will quite likely be intrigued by personal thoughts revealed by Adam, as put intriguingly to paper.

The lineaments etched meticulously, and expertly, by quite skilled wordsmith Adam show OCD in highly detailed (and, at times, slightly lurid) form.

Adam's writing is more plain English, stylistically, rather than rigidly academic; and, from time to time, elements of relative stylistic informality creep into textual crevices.

Across the length and breadth of the book, Adam proffers OCD centric discourse notable for its expertly informative and instructive nature and for its forthright candor.

In Chapter 1, Adam discourses that most people have strange thoughts; most shake them off, albeit some don't.  Adam reveals candidly that he turned his own strange thoughts into OCD.  It is asserted by Adam that there is much confusion about OCD:  although seen commonly as a behavioral quirk, OCD, in fact, is a severe and crippling illness. 

Intrusive thoughts are the substantive crux, of Chapter 2.  Adam informs readers that intrusive thoughts are everywhere.  Woven, with much intellectual skill, into the cloth of substantive discussion is expert comment reaching to:  obsessive thoughts of OCD, "ego-syntonic" thoughts, "ego-dystonic" thoughts, the so-called white bear effect, rituals, compulsions, and psychopaths.

With characteristic erudition, Adam, in Chapter 3, expounds on OCD and phobia.  Into the vein of discussion Adam injects comment

about the thinking of Sigmund Freud, regarding "obsessional neurosis".  Readers' attention is drawn particularly to a patient of Freud (the "Rat Man"), obsessed with thoughts of rats.  Readers' attention is also drawn raptly to the curious thoughts and behaviors of a French woman, from the early nineteenth century, known as Mademoiselle F.

Looking within the frame of OCD, Adam, in Chapter 4, intellectually sights a clear difference between a person with OCD and one with obsessive-compulsive personality disorder.  Opining that what can be called subclinical OCD is everywhere, Adam, in this context, focuses especially on the people of Dunedin.

Adam teaches, in Chapter 5, that hoarding is one of many separate conditions linked by scientists to OCD.  As the chapter's pages unfold, the gamut of wide ranging discourse extends to:  Tourette's syndrome, Parkinson's disease, sexomnia, kleptomania, trichotillomania, body dysmorphic disorder, hypochondriasis, anorexia, bulimia, and maladaptive daydreaming.

Adam states bluntly, in Chapter 6, that there is zero evidence that psychodynamics works with OCD.  Expanding on his bluntness, Adam adds that much of Freud's take on the causes and treatment of OCD looks ridiculous now, yet dominated approaches to OCD for decades after his death.  As Adam explains, attraction to Freud began to wane in the 1960s, when behavioural psychology muscled in on the field of OCD.  There is critical examination, by Adam, of aversion therapy.

Chapter 7 starts with the question:  If almost all persons experience intrusive thoughts, and intrusive thoughts are the raw materials for obsessions, then why do almost all persons not develop OCD?  Digging deeply, with an intellectual spade, Adam uncovers cognitive psychology and religion.  The observation, of intellectual excavator Adam, is that religion and OCD have walked hand in hand through the centuries.  In the enframing context of the link binding religion and OCD, Adam scrutinizes dysfunctional beliefs.  The cognitive theory of OCD garners Adam's didactically discerning attention.

Adam teaches, in Chapter 8, that animals, just like humans, show common patterns of ritual and behavior; and some of this behavior, Adam continues, may appear compulsive.  A possible link between OCD and evolution draws expertly instructive comment by Adam.  In this vein, Adam revealingly probes:  group selection, checking, compulsive washing, disgust, and consistency.

The sharp sighted intellectual vision of Adam, in Chapter 9, spots the issue of whether OCD is genetic.  What Adam sights is that, regarding possible genetic causes of OCD, there is not much to go on.  Adam teaches that the best guess of scientists, concerning OCD, is that genes and environment are about as important as each other.

In Chapter 10, there is intellectual elaboration by Adam of the relationship between the mind and the brain.  Adam likewise labors intellectually to elaborate critical understanding of magnetic resonance imaging ("MRI").  Adam informs readers that, over the last decade or so, hundreds of OCD patients have been MRI scanned; and again and again, a consistent picture of OCD emerges:  unusual activity in and around the basal ganglia.

Inside the frame of OCD, in Chapter 11, Adam substantively views:  sertraline hydrochloride, selective serotonin reuptake inhibitors, clomipramine, serotonin, dopamine, and oxytocin.

Discussion relating to OCD and cognitive behavioral therapy helps form the substantive composition, of Chapter 12.  As the chapter progresses, Adam expounds informatively on a treatment for OCD called exposure and response prevention.  There is, as well, discourse regarding the Total Perspective Vortex.

Lobotomy centric discourse forms the substantive cynosure, of Chaper 13.  Exhibiting characteristic bluntness, Adam opines that lobotomy has a dreadful reputation, that it deserves fully.  In a didactic manner, Adam adds much substantive flesh to the bones of topics ranging to:  ice-pick lobotomy, functional neurosurgery for psychiatric disease, frontal leucotomy, transorbital lobotomy, chlorpromazine, anterior capsulotomy, stereotactic surgery, and deep brain stimulation.

There is thoughtfully forthright comment by Adam, in Chapter 14, on the issue of problems and injustices associated potentially with OCD; and on increased awareness as a way to sort this out.  In Adam's opinion, OCD gets a raw deal in the media.  Displaying his customary candor, Adam tells readers that he can't think of a single positive thing about OCD.

At the start, of penultimate Chapter 15, Adam explains that OCD is no longer considered an anxiety disorder, having been officially reclassified in 2013, by the American Psychiatric Association, as a different type of mental illness.  OCD is now, as Adam explains further, one of the obsessive-compulsive  and related disorders.  The link between OCD and post-traumatic stress disorder is examined by Adam.  The possibility that CD may relate to schizophrenia is examined as well.  There is also critical discussion of the category approach, which, as Adam explains, places firm boundaries between different mental disorders.  Also drawing thoughtful comment is a way of thinking about mental illness called dimensionality.

In concluding Chapter 16, Adam opines that, if you think you may have OCD, the bad news is that it probably won't go away by itself; the good news is that scientists are constantly finding out more about OCD, and the best way to diagnose and treat it.

Seamless blending of discourse showing mastery of clinical and medical research data pertaining to OCD with discourse anecdotally recounting personal details of Adam's life will quite likely hold readers firmly in thrall.

At a professional level, the writing brilliance of Adam should be of particularly enthralling interest professionally, to scientists and clinicians working in the realm of mental health.


© 2015 Leo Uzych


Leo Uzych (based in Wallingford, PA) earned a law degree, from Temple University; and a master of public health degree, from Columbia University.  His area of special professional interest is healthcare.  Twitter @LeoUzych



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