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Compulsive Acts

UNIVERSITY OF CALIFORNIA PRESS

Contents

Preface.........................................ixPsychiatry by the Dumpster......................1[H.sub.2]O under the Bridge.....................39A Greek Tragedy.................................77With Any Luck...................................107One Eternity Drive..............................137References......................................163Acknowledgments.................................169Index...........................................171

Chapter One

George was special from day one. I can still remember Dawn, my clinic clerk, paging me at 1:45 p.m., three quarters of an hour after his first scheduled appointment, to warn me: "Oh, Dr. A., you're gonna love this one!"

"Please don't tell me the patient just showed up," I said. "How am I supposed to do a full intake in the remaining fifteen minutes?"

"I know," Dawn answered, "but I couldn't just let him go. I don't know what to say, but he's-how should I put it?-he has his reasons for being late ... He's special, even by our standards in this clinic, and even after nine years of doing this! I had to go out into the parking lot to check him in. That should give you an idea ...

"You went to the parking lot to check him in?" I asked. "Outside?"

"Yes, outside," Dawn answered. "He can't come in, he says. Our door isn't wide enough for him."

"Our door isn't wide enough?" I queried, wondering whether I was the right doctor for this patient. "Did he mistake us for the gastric bypass clinic? How heavy is he?"

"Oh, he's not heavy at all," Dawn answered. "In fact, his wife tells me he hasn't eaten in a few days. He's just ... I don't know ... Something about his nose ... He won't let anyone or anything close to it ... He was so worried about his nose, he wouldn't even get into the car this morning."

"How did he make it to our clinic, then?" I asked. "I thought he lived in Belmont. That's fifteen miles away."

"He does," Dawn said. "He walked here. His wife drove, but George walked."

"He walked?" I asked in disbelief. "All the way from Belmont?"

"All the way from Belmont," Dawn repeated. "That's why I can't simply send him back and ask him to reschedule. Anyway, he is checked in now and waiting for you over in the far corner of the parking lot, exactly three feet from the dumpster, where, I might add, his wife spotted your old, squeaky office table and asked me to help her pull it out and put it in her trunk. I'm no doctor, but she's not right, either ... What use could she possibly have for that table? Anyway, what would you like me to do now?"

"Well, I guess my only choice is to come right down," I said. "Meet me by the dumpster."

"OK, just remember not to get too close!" Dawn warned. "You might frighten him. And by the way, your two o'clock is here, too."

"Great! Is my two o'clock at least waiting in the waiting room?" I asked.

"Yes, she is," Dawn answered. "And I told her it was going to be a long wait ..."

* * *

I walked toward Dawn, who was standing in the far corner of the parking lot. Nearby, in a vacant handicap spot by our recycling dumpster, stood George. In the adjacent spot, having managed with Dawn's help to squeeze my old filing cabinet into her trunk, stood his wife, now trying unsuccessfully to push the trunk door shut.

George was a lean twenty-something, with wide green eyes and a sunburned face and neck, probably from having walked a very long distance in the midday sun to come to my office. His grooming and hygiene left something to be desired, and his dirty fingernails and caked hair indicated more than just the wear and tear of one day's walkathon.

His wife started the conversation. "Dr. A., thank you for coming out here to see us," she said, still intent on shutting the trunk, despite one leg of my old office table clearly sticking out. "I know this is not standard practice, but it's very difficult to get him through doors anymore. I read up on obsessive-compulsive disorder, so I know how to diagnose it. Heck, I may even have a touch of it myself ... We're here because we were told you were a specialist in OCD. It's urgent, Doctor! Things have gotten completely out of control since it's grown to three feet. Three whole feet!"

I was intrigued by the three feet but realized that I had not yet introduced myself to George. However, before I could formally do that, George preempted my handshake.

"I don't mean to be rude, Doctor," he said apologetically, "but please don't stick your hand out. I can't do handshakes."

"That's OK, I understand," I said. "I'm pleased to meet you anyway. Your wife just mentioned that 'it's grown to three feet.' What is it that has grown to three feet, George?"

"The radius around his nose," his wife answered, the quiver in her voice betraying her anxiety. "He needs that much clear space around his nose at all times. In the good old days, it used to be that nothing could come within a foot of his nose, and we could joke about it. But when the radius grew to two feet, it was anything but funny, and we started needing to make lifestyle modifications: having to sit alone in the backseat of the car, trying to sleep standing up like a horse, not to mention-if I may go there in your parking lot-the challenging sex ..."

I could see Dawn's face tense up at the idea of "going there." The sexual comment was clearly in poor taste for her and went against deeply ingrained prohibitions on discussing private sexual matters even in clinical conversations-that is, if you can really call a parking lot discussion a "clinical conversation." Dawn soon found an outlet for her anxiety, however: she strode over to the trunk, broke off the old table's leg, threw it inside, and snapped the trunk closed with a satisfying thud.

The sound of the trunk shutting and the thought of securing the old cabinet for her home also dissipated George's wife's anxiety, and a relieved smile made its way to her face.

"But then," she continued, more at ease, "even two feet weren't enough. It had to grow to three feet, and at three feet, it has been, well, impossible to accommodate!"

Steering the conversation back to the principal patient, I asked, "How long has this been a problem for you, George?"

"Oh ever since ... I don't know ... It sort of crept up on me," he answered.

"Ever since his brother died," his wife interjected.

"When did that happen?" I asked.

"Two years ago," George answered. "He died in a skiing accident."

"I'm very sorry to hear that," I replied.

If sex had been difficult to discuss in the parking lot, death would have been even more so, so I asked George, "I know this is hard for you, but can you try once more to come up to my office so we can continue this important conversation in private?"

"I can't. I'm sorry," George answered, cautiously shaking his head. "Doorways are difficult for me. Hallways are challenging. And elevators are out of the question."

"Nothing personal, Doctor," George's wife added. "His father was visiting from Europe, where he lives, last month. We hadn't seen him in two years. Well, George wouldn't even give him a hug! All he could do was wave hi from a safe distance when he arrived at...