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Book Review

‘The Man Who Couldn’t Stop’ by David Adam

Contrary to what many people believe, obsessive-compulsive disorder is not merely a behavioral eccentricity. For millions of sufferers, writes Nature Writer and editor David Adam in his first book, OCD is “a severe and crippling illness, and one defined as much by the mental torment of recurring strange thoughts as physical actions such as repeated hand-washing.”

As the author rightly notes, everyone has intrusive thoughts — ridiculous, even reprehensible ideas boiling up from somewhere in our unconscious minds. Not all of us, however, choose to act on them or spend every second of every day analyzing them, attempting to purge them from our brains, or engaging in time-consuming, even life-paralyzing actions to cope with them.

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“Put simply,” writes Adam, “most people with OCD develop their compulsions as a way to make their intrusive thoughts go away.”

In what is “not intended as a self-help book” — thankfully, though OCD sufferers will find plenty of useful information, as well as solace, throughout — Adam interweaves his personal history of OCD with the history and science of the disorder and a host of edifying and oddly entertaining stories about a variety of bizarre cases. Thankfully, the author only briefly discusses the infamous case of Howard Hughes, the reclusive billionaire whose OCD crippled his ability to live a normal life (see Leonardo DiCaprio in “The Aviator’’). It’s a well-worn tale and one with little application for many sufferers.

Adam’s experience with OCD likely began in August 1991 with the unbidden thought that he could have HIV/AIDS, which led him to a host of contamination-related obsessions and attendant compulsions. Like many other sufferers, the author was unable to rid himself of the thoughts, even though he was well aware that they were irrational — he understood, after all, that he could not contract HIV merely from pricking his finger on a metal shed. Still, “[o]bsession has no regard for rational explanation. No pathology of thought can be solved with more thought.”

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The author’s learned but conversational tone when discussing the scientific background of OCD and related disorders is inviting — readers may be reminded of Elizabeth Kolbert’s tone in her excellent “The Sixth Extinction” — and the psychological jargon is usually quickly explained or leavened with an apt example, some more grotesque than others: One of Sigmund Freud’s patients, the “Rat Man,” battled against a mind “filled with a sadistic vision that caged rats would be tied to the buttocks of his loved ones, and forced to gnaw through their anuses.”

Such cases are obviously the extreme, and while they add interest Adam does well to keep the proceedings within a range that will prove comforting to fellow sufferers. Unfortunately, the author admits, there are few concrete solutions to be found regarding the biological causes or indicators for OCD (readers more interested in the neuroscience should look elsewhere) — though Adam has had success with cognitive behavioral therapy, which, along with appropriately prescribed drugs (SSRI’s have been particularly successful), is generally accepted as the most useful practice for living with OCD.

In places, the author is overly jokey, trying too hard, when he should let his accessible, fluid tone and extensive research carry the narrative — after summarizing a patient’s suicide attempt, which failed to kill him but left him with a prefrontal lobotomy, Adam writes, “Do not try this at home.”

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For the majority of the book, however, the author is a capable, informative, and well-intentioned guide, illuminating the darker corners of OCD while demonstrating certain areas of promising research. Throughout, Adam maintains an evenhanded and encouraging yet candid tone. While “OCD dissolves perspective . . . magnifies small risks [and] warps probabilities,” as the author has discovered and shown to readers, it can be managed and even overcome.


Eric Liebetrau, managing editor and nonfiction editor of Kirkus Reviews, can be reached at eliebetrau@kirkus.com.