He wouldn’t call it vindication, but my patient can hardly hide an air of “I told you so” as he contemplates a world that, overnight, has developed some familiar obsessions and compulsions. “If everyone had been doing what I’ve been doing all along, maybe we wouldn’t be here,” he says. By “here,” he means the virtual clinic where, under San Francisco’s shelter-in-place orders, he’s meeting with me, his psychiatrist, by videoconference.
It didn’t take a viral scourge for my patient, a graduate student with contamination-based obsessive-compulsive disorder, to adopt behaviors now considered lifesaving. The Centers for Disease Control and Prevention’s guidelines mirror the rituals he has performed for years: Wet your hands with running water; turn off the tap; apply soap; scrub your hands, including the backs, between the fingers and under the nails (humming “Happy Birthday” twice is optional but a 20-second duration is not); rinse your hands under running water; dry them completely.
He has been doing this before, during and after preparing food; before eating; before and after caring for his baby and his sick grandfather; after using the bathroom; after sneezing, coughing or blowing his nose; after touching his dog, dog food or dog waste; and after touching garbage. He has long kept people at a distance equivalent to his height: 6 feet.
How could my patient have independently adopted what must have taken epidemiologists, infectious-disease specialists and statisticians years to generate? The answer might lie in the evolutionary hypothesis of OCD.
Giraffes with long necks could reach high-up food sources and thereby survived to reproduce at higher rates than short-necked giraffes. In a similar process of natural selection, humans with a psychological horror of germs survived the evolutionary competition with germ-neutral ancestors. OCD may represent the extreme end of an adaptive trait that protected our progenitors from diseases potentially far worse than Covid-19.
Full-blown OCD, however, is often accompanied by severe anxiety, which even innocuous triggers can set off. Like a smoke detector, there’s a sweet spot for one’s anxiety threshold: If it’s set too high, you run unacceptable risks; if it’s set too low, it will sound nonstop. For my patient and others, the alarm is always ringing, causing them to freeze before the minor risks and uncertainties that give life its color and fullness.
“Everyone is being OCD now,” my patient says. OCD is no longer only something we have. It’s something we’re under county, state and public-health authorities’ orders to become. “But they’re not doing it right,” my patient laments. He has a point: Social-distancing and hand-washing guidelines often are heeded improperly or only briefly before “OCD fatigue” sets in and caution is abandoned.
Evolution preserved a lifesaving anxious trait for us to tap into when needed. To use it right, we can look to people like my patient for discipline and inspiration. A little OCD, right now, wouldn’t be so bad.
Dr. Aboujaoude is a clinical professor of psychiatry at Stanford.
Copyright ©2019 Dow Jones & Company, Inc. All Rights Reserved. 87990cbe856818d5eddac44c7b1cdeb8