No day passes in my OCD clinic without a patient teaching me something new or introducing me to an unusual symptom I had not heard of before. Although most people are familiar with the “classic” manifestations of OCD—excessive cleaning, extreme superstitiousness, checking of door locks and the stove, etc.—the symptoms of this serious illness are endlessly variable. Natalie* is a case in point.

Natalie is a forty-five-year old woman who works as an accountant at a San Francisco software firm. In the tremulous voice and downcast eyes of someone embarrassed by a long hidden secret, she shared with me a peculiar checking ritual that has impaired her for years.  She described how, while still in college at age 20, and for no reason that she could point to, a strange anxiety suddenly hit her: Natalie started worrying that she may have inadvertently stepped on a baby during her morning jog. Where the baby would have materialized from on the isolated river-side trail where she ran, or how she might have tripped over it and not noticed, she could not say, but the need to verify that she did not stomp on a baby Moses whose mother had left him by the river was so intense, that she started to follow her jog with a slow-paced hike during which she would comb the trail for any evidence of her “crime.” As a result of the time-consuming pattern, Natalie had to avoid morning classes, but, once the ritual was completed, she could focus on afternoon lectures and on doing her homework in the evening, knowing that she had no blood on her feet.

After graduating, because the corporate world she chose to work in was less accommodating of late starts, Natalie stopped jogging. Two decades later, her more sedentary lifestyle has caught up with her in the form of significant weight gain and early blood pressure problems. But not running did not mean renouncing compulsions. She still makes time to calm down an anxiety that mutated over the years but never went away: Natalie’s commute today involves a twenty-minute drive from her home to her company’s headquarters. Depending on her level of anxiety, that trip is sometimes followed by another drive during which she retraces her steps to ascertain that she did not run over a baby on her first attempt to get to work. On “bad days," she even has to check her tires for reassurance and any hints…

Natalie shared with me the GPS trajectory of her morning commute (from her home in San Francisco's Pacific Heights neighborhood to her office downtown, then back to Pacific Heights, then on to downtown). Superimposed on a smart phone topographical map of the hilly city, the way her route crisscrosses the landscape evokes a Jackson Pollock painting and presents a moving mixture of deep anguish and strange, abstract beauty. It also drives home a lesson I relearn every day: The shades of mental suffering are infinite.

*Identifying details have been altered to protect privacy.

About the Author

Elias Aboujaoude M.D.

Elias Aboujaoude, MD, is a psychiatrist and author based at Stanford University. His most recent book is Virtually You: The Dangerous Powers of the E-Personality.

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