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TitleThe Man Who Couldn't Stop: OCD and the True Story of a Life Lost in Thought
File Size1.0 MB
Total Pages236
Table of Contents
                            Title Page
Copyright Notice
One: Our siege mentality
Two: Bad thoughts
Three: The mademoiselle and the Rat Man
Four: An emerging obsession
Five: The OCD family
Six: Cruel to be kind
Seven: The God obsession
Eight: Animals and other relatives
Nine: Man hands on misery to man
Ten: The runaway brain
Eleven: Daddy’s little helper
Twelve: The helicopter view
Thirteen: Long live lobotomy
Fourteen: Politics and prejudice
Fifteen: A new dimension
Sixteen: Final thoughts
Notes and references
A Note About the Author
Document Text Contents
Page 118


The runaway brain

A popular way to visualize the brain is to clench your fist and stick your thumb
out and point it at the ground, as if you are a Roman emperor passing judgement
on a defeated gladiator.* Your thumb is now the brain stem and the thumbnail
the end of the spinal cord. Your fingers and hand represent the cortex, with the
little finger the pre-frontal cortex. Now, do the same, but first squeeze a grape in
the grip of your index finger. The grape contains the seat of our obsessions.

The relationship between the mind and the brain is one of the most
mysterious in modern science. At their most basic, the thoughts that cause such
mayhem in OCD are just electrical and chemical signals. But to say those
physical elements alone define and confine the mind would be to say that the
Mona Lisa is just some paint. There is a point at which this material pragmatism
seems to give way to something greater, a frontier beyond which the sum is
greater than the parts. In the brain, that is the moment at which the chemistry and
electricity, the nuts and bolts, combine to form the mind, to give humans the
sensation of consciousness.

Take the separation of brain and mind too far, and you hit the scientifically
awkward idea of a soul – that the mind can and perhaps does exist in isolation of
its physical basis. But, refuse to accept the notion of a mind−brain duality at all,
and we struggle to explain the human experience. It’s a problem as much of
philosophy and metaphysics as one of biology.

Biology has one clear advantage over philosophy and metaphysics: it can be
measured. But it’s natural for scientists to measure either the mind or the brain.
Even as modern science scoffs at the false premise of dualism, it inadvertently
reinforces it. Neurologists work with brain tissue. Psychologists grapple with
functions of the mind. Psychiatrists have a foot in both camps; they diagnose
problems of the mind and treat them as problems of the brain, which is perhaps

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why psychiatry is sometimes regarded with suspicion by both sides.
Since the days of Esquirol and Freud, OCD has been viewed as a problem of

the mind. Except, of course, OCD wasn’t viewed, not in the literal sense, it was
conceived, modelled, reimagined. Modern technology, however, now allows the
brain to be viewed in the literal sense. And that literal view, some neuroscientists
believe, can show us the physical basis of OCD.


Only a fool or a liar will tell you how the brain works. Even well into the
twentieth century, while scientists in other fields could harness technology to
split the atom and unravel the molecular structure of DNA, neuroscientists were
largely restricted to two types of experiment. They could remove and look at a
dead brain, or they could watch for the effects of brutal accidents and dreadful
disease on a live brain. The nineteenth-century scientist Paul Broca famously
unravelled how the brain processes language with the help of stroke victims who
lost the ability to speak. By the 1960s, Canadian neurosurgeon Wilder Penfield
made maps of cognitive function with electrical stimulation of the exposed
brains of wide-awake epileptic patients he was poised to operate on, to see which
part of their bodies activated – the patients might twitch their shoulder or report
a memory.

Neuroscience became more high-tech in the 1970s with devices to analyse
live brains – an alphabet soup of acronyms. First was the CAT scan, computed
axial tomography – which combines X-ray images taken from various directions
– and the PET scan, positron emission tomography, which maps radioactively
labelled chemicals injected into the bloodstream. Most influential was MRI,
magnetic resonance imaging, based on a tool that research chemists had long
used to probe molecular structure. The chemists called the technique nuclear
magnetic resonance, and one of the first things that doctors did when they started
to point the machines at their patients was to drop the word ‘nuclear’ from the
name. The patients preferred it that way.

MRI uses magnets and radio waves to detect blood. Particularly useful to
neuroscientists is functional MRI, which takes lots of scans, one immediately
after the other, and so shows how the blood moves. Blood flow in the brain
means activity. If one part of the brain shows a greater demand for blood, or in

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* Pitman last saw him in 2000. ‘He gets by,’ he says.

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* You can take the Yale-Brown test online at

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