Compulsive behavior often fascinates us, as long as it’s afflicting someone else.
Compulsive behavior often fascinates us, as long as it’s afflicting someone else. Despite all the accomplishments in his storied life, business tycoon Howard Hughes is perhaps best remembered for his later years spent as a germ-phobic recluse who stored jars of his own urine. An entire subgenre of reality TV deals with interventions for hoarding, morbid obesity, drug abuse, gambling and all other manner of self-destructive behavior. We often see a piece of ourselves in these lurid stories: who hasn’t heard someone else say that they were “addicted” to a certain food or new product; or that they “binge-watched” their favorite Netflix show; or that they’re “a little OCD” about something. Sharon Begley’s Can’t Just Stop: An Investigation of Compulsions deftly shines a light on a blurry subject (even by the standards of the already imprecise mental health field) and does so in such a way that doesn’t allow scientific rigor to supersede the humanity at the heart of these stories about behaviors gone haywire.
Early on, Begley makes the important distinction between compulsion and addiction. They’re often treated as interchangeable terms, but their mechanisms are vastly different. Most notably, addiction often develops as a result of pleasure-seeking, while compulsive behaviors stem from their ability to relieve overwhelming anxiety. On the one hand, addiction usually involves risky behavior, while compulsion is risk-averse, often performed with a misplaced belief that the illogical act will prevent something terrible from happening. Begley vividly writes about the tribulations of those suffering from obsessive-compulsive disorder, people who know that their actions are irrational yet feel as though some outside force nevertheless demands they act. She cites one woman who compulsively checked her refrigerator to ensure her cat wasn’t trapped inside, even moments after seeing her cat slink cross the living room. “Better safe than sorry” taken to the extreme is the mantra of OCD.
Begley also points to distinctions between someone with OCD, who knows their actions are irrational but can’t help doing them anyway, and someone with obsessive-compulsive personality disorder, who would insist that the highly intricate way they perform tasks, such as ensuring the decorative bath towels are all hanging precisely even with each other, is the only rational and correct way to live. You can see how many psychologists have a difficult time even diagnosis compulsive behavior, and how it can be grossly undertreated.
Matters get even more complicated when religion gets thrown into the mix, and Begley does a fine job of providing historical examples of compulsion manifested in eras when leeches were medical supplies and exorcisms were the standard treatment for mental illness. In the modern day, compulsions can prompt even the most pious to believe that they haven’t acted righteously enough, or even to obsess over the notion that they’ve accidentally been praying to Satan the whole time. Begley recalls one man who believed he’d lied to his wife simply because he told her the forecast called for sun and he’d later spotted a single cloud.
Begley spends much of the time parsing the differences between addictions, impulse-control issues and compulsion, which is often muddy. She discusses how video game designers have occasionally exploited knowledge of brain chemistry to hook players with their various reward systems. Now and then, she gets bogged down in clinical details and statistics, but she more often keeps a good balance between the science and the stories. We meet one man who became obsessed with the notion he might have accidentally sustained a head injury and compulsively sought CT scans, to the point that he’d demand a second one immediately following the first. And the account of a domestically abused woman slowly descending into hoarding makes for one of the more compelling passages, and points out why we’re so fascinated with the motivation behind the phenomenon of hoarding: because stockpiling what most people know to be trash “is all about potential, about keeping actualities at bay.”
The fact is, even as advancements in mental health research increase, there’s often no hard line between eccentricity and unhealthy compulsion. Can’t Just Stop succeeds in drawing awareness to often overlooked maladaptive behaviors that often start out as no big deal until one day they become all that matters.