This cleaning lady had the telltale signs of OCD which affects about one in fifty members of the general public. In many instances OCD reflects concerns about the consequences of failing to do something – lock doors or turn off power switches. The most common one that most of us experience is the checking and then rechecking that we have taken our passport when travelling. No matter how many times we confirm that we have it, for reassurance we still feel compelled to check.33 Many of us also have routines that punctuate our daily lives and we prefer not to deviate from them. It might be the way you read the sections of the morning paper in a specific order or how you typically start off your workday. Sometimes these routines become rituals that control and dominate our lives. In one notable case, a British boy with Tourette’s had OCD that compelled him to step correctly on a white road marking. On the morning of 11 September 2001, he neglected to fulfil his compulsion and ended up traumatized because he believed that he was personally responsible for the attacks.34
The OCD Circuit
The symptoms of OCD are the obsessions (the relentless intrusive thoughts, usually about something bad happening) and the compulsions (the repetitive, ritualistic behaviours often enacted to alleviate the obsessions).35 Karen, a thirty-four-year-old mother of four, used to obsess that some harm would befall her children unless she carried out certain counting rituals. For example, when she smoked and drank coffee, she had to smoke four cigarettes in a row and drink four cups of coffee, otherwise something bad would happen to her children. She knew this was irrational, but if she didn’t perform her counting ritual, she experienced extreme anxiety.36 This sets up a feedback loop in behaviour whereby performing the ritual alleviates the mental anguish and strengthens the grip OCD has over its sufferer.
What starts this cycle of ritual off in the first place? The obsessions that plague sufferers typically derive from concerns that could pose a real threat such as contamination fears. What appears to go wrong is the evaluation of the perceived threat and the proportional balance of engaging in behaviours to address those concerns. This must be due to a brain disorder that is as yet not fully understood but may be linked to Tourette’s syndrome. There is certainly a heritability factor with OCD, running higher in families, and more common in identical than non-identical twins.
One current theory37 is that there is an imbalance of activity of the PFC, the ACC and the caudate nucleus (CN) of the basal ganglia – the so-called ‘OCD circuit’. Functional imaging reveals that activity within this corticobasal ganglia network is higher in OCD sufferers compared to normal individuals, and increases during provocation of symptoms, but that it is attenuated following successful treatment.
The PFC supports the executive functions for planning and suppressing thoughts and behaviours while the ACC interconnects the frontal lobes with the limbic system of the midbrain and is related to motivation. Together, the PFC and ACC may signal the perceived importance of stimuli that trigger ritualistic behaviours. The CN is involved with initiating intentional behaviours. For example, disruption of this region can result in the inability to start movements (as in Parkinson’s disease) or an inability to stop movements (as in Huntington’s disease). Drugs that increase activity of the serotonin neurotransmitter, which decreases the activity of the CN, have been found to alleviate the symptoms of OCD. But that does not mean that the disorder is caused by overactivity of the CN. Rather, it may simply be a consequence of the behaviour, which is why therapies that work to limit the compulsions seem to produce a reduction in caudate nucleus activity as well.
The work on the brain circuitry of compulsions and ritualistic behaviour is another clear line of evidence to support the proposition that the self most of us experience is an illusion. This work reveals that we are in constant conflict with competing goals and drives and for some unfortunate individuals, pathological behaviours reveal when the competition gets out of balance. This is the web metaphor again. You might argue that these victims have a self that is not in control and would prefer not to have to engage in rituals in the same way that an addict would prefer not to be addicted. However, evoking an idealized notion of what we would want to be does not mean that this individual, the Great Selfini, necessarily exists.
Ego-Depletion
The young Japanese actress is a quietly spoken, twenty-four-year-old former ballerina, with a perfectly symmetrical angular face and long dark hair – so typical of Asian beauties. Aoyoma has large almond eyes and an enchanting smile. She is the director’s on-screen visualization of vulnerability and innocence. But her performance in the infamous torture scene in Takashi Miike’s cult horror, Audition (1999), is so shocking and indelible that it instantaneously propelled this movie into cinematic notoriety. Believing that all men lie, the beautiful but psychotic Aoyoma tells her lover that, ‘Pain never lies,’ as she proceeds to stick needles into his eyes, chirping sweetly, ‘Kiri … Kiri … Kiri’ (‘Deeper … Deeper … Deeper’). She then amputates his left foot with a wire saw, laughing gleefully, like an innocent child as we watch the bloody gore, hear the sound of serrating bone and the ‘ping’ as the wire recoils through the stump. It is so cinematically graphic that most people in the audience squirm in their seats, cover their eyes or simply walk out of the cinema.
Most people, that is, except for those taking part in psychologist Matt Field’s experiments at Liverpool University. Field was showing them the infamous Audition torture scene for a study on self-control. Half of the student volunteers were told not to turn away and that they must not show any emotion. They had to resist the nausea and overwhelming feelings of disgust. They had to watch the violence through gritted teeth. They had to control themselves. The other half of the group simply watched the torture scene but were allowed to respond naturally. They were nauseated. They were disgusted. Many closed their eyes. One student fainted. Their mirroring system had gone into empathetic meltdown.
What kind of sadist is Matt Field? How did this study ever get through the university ethics committee? Actually, he is a very likeable chap who is trying to understand some of modern society’s worst scourges – alcoholism and drug addiction. It turns out that after being forced to sit through an extreme Japanese horror movie, those participants who were instructed to control their emotions needed a stiff drink.38 After filling out some bogus questionnaires, both groups were allowed to have as many beers as they liked as part of the reward for taking part in the study. The group that was forced to suppress their emotions drank half as much again as the group that was allowed to wear their hearts on their sleeves. The effect was massive. And it doesn’t have to be extreme horror. Tearjerkers, like Terms of Endearment, also compel us to respond emotionally, but if we try to suppress our feelings this makes us vulnerable to temptations.
Field, along with a growing body of addiction experts, believe that self-control or willpower is a key component to understanding why some of us succumb to substance abuse after enduring stress. Whenever we exert self-control, it comes at a cost – a cost that makes us more susceptible to temptation later. This may be one of the reasons why so many of us give into behaviours that are potentially self-defeating. Most of us drink too much, eat too much or engage in activities that we would prefer to avoid or at best limit.39 And yet, most of us fail, despite our best intentions to control our behaviour.
Roy Baumeister is a psychologist who believes in the concept of willpower and the reality of the self.40 He does not think it is an illusion. Moreover, he thinks the self has three different components: the self as subjective awareness (‘I’), the self as defined by relationships with others (‘me’) and the self with the mental muscle power to make decisions and avoid temptation (executive functions). Whenever we succumb to the temptations we would rather avoid, Baumeister calls this ‘ego-depletion’ as if the self has some kind of mental muscle that can become fatigued.41 With self-control, there is only so much effort you can allocate, and when this becomes depleted you become vulnerable to behaviours and thoughts that want to take over.