Matthew Weldon's Dangerous Thoughts

Obsession, Compulsion, and Bowls of Hot Brown Piss

(I pitched this essay to a local online publication. They did not respond.)

It is half past eight on a frosty December morning, and I am standing on the pavement outside my flat shivering in the cold. Traffic is bunched up across all four lanes, and exhaust fumes sit like a heavy mist, making christmas lights of fog lamps and indicators. An inveterate work-from-homer, this is the first time in a good couple of years that I’ve had to be up and about so early. Today is a very special day. 

A taxi pulls up, a Skoda something or other (all taxis are Skoda something or others). I open the back passenger door and offer my name as a question. “Matthew?” He repeats it back affirmatively. “Matthew.” I climb in. He says “Queen Elizabeth University Hospital”? I say yes. We drive off.

My driver is the kind of gibberer that only Glasgow can produce, charmingly well-natured and frustratingly incorrigible. He has woken up with an appetite for chat, and he does not stop to consider whether the man en route to hospital might be less keen on conversation. For the record, I am less keen on conversation, but that’s my failing. When he asks “this you heading to work?” then, I reply with a false enthusiasm. I consider lying, because lying would be much easier here – perhaps even advisable. But a catholic education leaves deep wounds, and even the thought of slightly misleading this complete stranger threatens to open them all. On balance, this probably makes me a better person. It certainly makes me a worse passenger.

“No” I reply, “I’m actually heading in to be part of a study.” It does not seem to cross the driver’s mind that I may not want to describe exactly what kind of medical experimentation I am to be subjected to. I see his wide eyes in the rearview as he asks me what sort of study it is. “It’s a study for a new kind of OCD medication.”

This is a slightly streamlined version of the truth. I’m actually en route to have my eligibility to participate in a study for a new kind of OCD medication evaluated. There has been an advertising campaign, plastered across Subway stations and carriages, encouraging people who have been diagnosed with OCD or who think they have OCD to come and join in the highly-regulated, double-blind fun. I fall into the latter category, having never been diagnosed by a doctor, but I certainly live like I have OCD. I am medicated like I have OCD. And if it looks like OCD, sounds like OCD, and thrice-turns the lights off before leaving a room like OCD… 

Naturally I stumble through this disclaimer almost immediately, because the driver’s first question is “so do you have OCD then?” and “yes, definitely” would be lying, and god forbid I don’t accurately describe my medical history to this stranger. But I don’t want to seem like one of those people who claim to have a debilitating mental disorder just because they like their pencils neatly arranged in order of size, so I start to justify myself. To the taxi driver. I have not been in the car two minutes and I am telling this man things I have never told another living soul. I confess my innermost fears, and the things my brain does to cope with these fears. I talk about my medication and its beneficial and detrimental effects. We’re not even nearly there yet. In fact we’re barely underway. My flat is still visible through the rear window.

This thorough synopsis of my insanity is a red rag, and immediately the bull charges. His eyes spend more time locked with mine via the rearview mirror than they do on the road as he relays the story of his local obsessive-compulsive, a friend who is tortured by terrifying fears of his house burning down. He can barely cross the threshold before horrifying visions start to taunt him, and so to manage he has to document everything before he leaves. His camera roll is full of photos of hobs, sockets, plugs. The driver tells me that, more than once when his friend has been abroad, he’s had to go round and visit the house following a 2am phone call insisting that the iron has been left on and that his house is burning down. It’s harrowing stuff, and more harrowing still is I can relate to every detail.

Then the taxi driver chuckles to himself and says “aye. He’s fucking mental.”

—

OCD is the unending struggle to be sure. The obsessive compulsive brain cannot handle being unsure, so it tries to make itself sure through compulsions. You’ll have heard of some of these – obsessive handwashing, constantly trying the door to make sure it’s locked, turning all the plug sockets off before you turn your back on them. These compulsions might seem illogical to you, completely divorced from reality – thing is, most OCD sufferers will agree with you. They’ll still be unable to stop them. Compulsions make them feel more sure, and their brains value that surety, so their brains reinforce the compulsive behaviour, making it more likely that they’ll do it again. But each time they engage in the compulsion, the neurochemical reward is a little less potent. The surety is lessened, so they need to do the compulsion more. And on and on and on, forever.

That’s a very bare-bones view of OCD, obviously, but it captures the essentials. If you remember one thing going forward, let it be this: certainty is the one thing OCD craves.

When I arrive at the research facility on the Queen Elizabeth University Hospital campus, I am certain that the day cannot get any worse. I relay the story of the taxi driver to the nurses. They are clearly mortified, and they apologise profusely despite having nothing to do with it. I’m shown to a very pleasant private room, well outfitted with the sort of thing you don’t generally expect in hospitals. There are plants, and a nice wooden screen, and comfy chairs. In the corner of the room there’s a cozy-looking bed. There’s an en suite too. The room is stiflingly warm. I consider how nice it would be to climb into the bed and fall asleep here.

There’s no time for sleep though, because the nurses are in and out and in again. I should stress at this point that the nurses are wonderful. Friendly and warm, you start to forget that you’re here for anything that might be considered at all unpleasant. Instead it’s like a hotel, albeit one where the staff wear scrubs. I’m offered coffee, tea, fizzy drinks, biscuits. The biscuits, I’m told, are excellent on account of the study being funded by a pharmaceutical company rather than the NHS. If you get the chance, participate in an OCD medication trial: you’ll be obsessed with the snacks.

Once I’m fed with biscuits and fizzy with cola, an endless procession begins. First a doctor comes in and introduces herself. She tells me she is leading the study, or at least the Glasgow portion of it. She thanks me for taking the time to be here today and explains a little bit about the study. She also describes the nature of the tests they’ll do today. There will be some questionnaires, which I’ll be led through by a doctor, and some physical tests too, just to make sure I’m not falling apart. It’s a very thorough summary, at the end of which she excuses herself. I am once again alone in the warm room, contemplating naps.

There’s a knock at the door, and a second doctor enters and introduces herself. She thanks me for taking the time to be here today and explains a little bit about the study. She also describes the nature of the tests they’ll do today. There will be some questionnaires, which she will lead me through, and some physical tests too, just to make sure I’m not falling apart. It’s a very thorough summary, at the end of which she excuses herself. I am once again alone in the warm room.

This is pretty much how science works. As a human test subject in a medical trial, you will be told about the nature of the trial on the phone, and then again in person, and then again in person, and then you’ll be given a printed form on flimsy sepia-tinted paper and that paper will contain everything you’ve been told three times already and then you’ll get another copy of that same form and you’ll be told that one of them is for the research team and one of them is for you and you’ll have to sign them both to confirm that you have been given the same information many, many times and you definitely, absolutely, beyond any reasonable doubt and no-take-backs (actually, some-take-backs) understand what’s about to happen to you. It’s not the researchers’ fault obviously, it’s just how you do science when there are humans involved. Mice are lucky; they don’t endure exposition like this before their brains are scooped out.

But soon I long for the monotony, because my certainty was unfounded; the day sours. It’s important to understand this, so I’ll say it again: everyone working here is unfailingly lovely, but the coalface of science is dispassionate, analytical, and fundamentally unkind. If I’m to participate in the study, we need to check if I have OCD. There is no blood test for OCD, no lateral flow or PCR test, no lumbar puncture or cheek swab or anal probe. Like most other mental disorders, OCD is diagnosed by questionnaire. This I’d expected, but what I hadn’t counted on is the kind of questions I’d be asked. These are not softball questions. They are stark, abrasive protocols, designed without people in mind. They aim to eliminate diagnoses that might appear at first glance to be OCD, but on closer inspection smell of something else. Over the course of two or more hours, I am subjected to a barrage of questions that would give even the taxi driver pause.

Batten down the hatches, because the skies are getting greyer. The questions go on and on and on. They’re organised by disorder – questions on ADHD, schizophrenia, major depressive disorder, psychosis, paranoid delusions. Do I hear voices? Do I see people? Do I ever think I am being followed? Do I ever have periods of low mood? How long do those go on for? Have I ever thought about this? Have I thought about it in the last thirty days? Have I ever made plans to do that? Have I attempted that in the last thirty days?

I tell all; every embarrassing story, every ludicrous compulsion, every fear. I do it with my trademark winning (read: annoying) charm (read: frustrating inability to engage with things sincerely). The doctor says, more than once, “I’m sorry about this, but I have to ask.” I say it’s OK, and then she asks, and then I understand why she apologised. This happens over and over again for a couple of hours, and the longer it takes the more certain I become that the doctor will conclude by saying that I don’t have OCD, but am instead almost inconceivably mad. I am the type of mad that used to get a person locked in a room with yellow wallpaper. I am the type of mad that previously might only have been treated by hooking my brain up to a weathervane during a thunderstorm. I should be locked away with Renfield, passing the time building my army of spiders.

And then it ends. The doctor apologises again and leaves, saying she’ll give me some time to relax a bit before the physical portion of the exam. This is not promising, because as bad as my mental health is, my physical health is, without question, worse. I sit alone in the very hot room, wondering if I am sweating because the room is very hot or because I’m stressed and a bit shaken. I reason that it is probably a bit of both.

Don’t stop sweating yet, though – we move on to the physical assessment. I am placed on one of those freestanding measuring stations that sit in the corner of all doctor’s offices. I have put on quite a bit of weight, which annoys me, but as consolation I have also grown by an inch. Then there are blood pressure cuffs, reflex hammers, stethoscopes, needles, and more questions. What’s my age, how much do I drink, have I had any ecstasy in the past few months and do I plan on having any ecstasy in the next few, that sort of thing. I’m also asked about the likelihood of my getting anyone pregnant if I am enrolled on the trial. I assure the nurse that the type of sex I am interested in having makes it difficult to conceive, and that the type of people I am interested in having that sex with generally aren’t interested in having that sex with me.

The last test is perhaps the least pleasant of all, for all involved. I am given a small foil bowl and am politely asked to take myself to the toilet and piss in it (verbiage mine). This I do, sitting it on top of the toilet and aiming carefully, dreading a sudden fork. Once finished I summon the nurses back in, one of whom enters while pulling on a tight pair of nitrile gloves. It’s only as she exits, moving excruciatingly slowly to avoid sloshing piss over the side of the bowl, that I begin to wonder if I somewhat overestimated the quantity of piss required. I also start to wonder if I should have drank more water leading up to this. I lamely cry “sorry” after her, and she shouts back “all part of the job”. I idly wonder how much I’d need to be paid to ferry around bowls of hot brown piss all day.

The nurse returns remarkably quickly: the piss is fine. I realise I don’t know what the test was actually for, but presumably this means I’m free of any methamphetamines, pregnancies, or venereals. I don’t know how they test for all these things within the span of two minutes. Maybe it’s because they were working with such a vast quantity of piss, and that sped things up. Maybe.

—

And that’s that. I have been tested. It is over. The doctor who took me through the questioning returns to debrief me. She briefly summarises everything we talked through, the medical tests they’ll send away for, what the next steps will be, how long it will be before I can expect to hear back, what will happen if I am progressed through to the trial. She asks me if I have any further questions, so I clumsily stumble through the one I’m compelled, compulsed, to ask.

“I appreciate you might not… er… that is, you’re not my GP, so if you can’t then that’s absolutely fine, only it would be good to know, just for myself obviously, but to know if… hm… based on what we’ve discussed today, do you think I have OCD?”

She speaks with a great deal of calm and warmth. Her voice is steady and reassuring, not a trace of judgement or exasperation, and she says: “based on what you’ve told me today, if you came into my clinic, I would be very confident in diagnosing you with obsessive compulsive disorder.”

Then I do something quite unexpected: I begin to cry. Not big shoulder-shaking sobs, nothing so dramatic. Just a single teardrop. Think Chris Pine at the Oscars, a very stoic sort of crying. The nurse grabs a box of tissues and offers me one, which I take and dab on my face like I’m watching my son go off to war. I say “I’m sorry, I’m not sure why I’m crying.” The nurse replies:

“It’s a big thing.”

Using barely any words at all, she’s distilled it down to its essence. It is a big thing. It has been a big thing for a while. It has sat on my shoulders and weighed on me for years, wrapped itself round my legs and hobbled me, all the while whispering lies and half-truths, talking me into insane flights of fancy and bizarre coping mechanisms. It has made me irrational and irritable and irritating, it has sat in the corner of the room refusing to be moved, it has dominated years of my life. It has sentenced me to a lifetime of phoning up doctor’s offices and asking for repeat prescriptions and saying “this time could I get the same number of 100mg and 50mg pills so I’m not running out of one before the other” and a lifetime of opening the brown paper bag and disappointingly finding they’ve cocked it up again (which feels especially poor when you’re treating an obsessive-compulsive). But in naming the demon, I can begin to exorcise it. I have been handed a map, the tools, hope. And that’s a big thing.

I stop crying, and the nurses kindly summon another taxi. The driver on the return journey isn’t as talkative, shrewdly discerning that someone on their way back from hospital might not be too inclined to discuss their reasons for being there. By the time I make it home it is lunchtime for my cat, who greedily tears through the dry food I put out for him. Everything is pretty much the way it was when I left that morning, other than me. I am a little lighter, perhaps a milligram or two more optimistic. And I think I know why. I have certainty now – and that’s the one thing OCD craves.