You've probably heard a friend describe themselves as "a little OCD." Perhaps you know someone who always cleans the shared kitchen at work and leaves notes for those who mess it up. Maybe your cousin can't put their smartphone down when you go to dinner. All of these are manifestations of compulsion. Compulsion can be an irresistible force, one that surfaces as a response to our own anxieties. It can drive you to shoplift, to count the number of red doors, or to hoard every copy of the New York Times you can get your hands on. Or it can be as innocuous as your need to wipe down your computer keyboard before you start work each morning.
In her book Can't Just Stop: An Investigation of Compulsion, Sharon Begley, who is the senior science writer at the Boston Globe, probes exactly what compels us. Begley searches for the line between acceptable, even helpful, compulsions and diagnosable disorders, following the latest changes in thinking from the American Psychiatric Association. She looks at hoarding, when a person can't stop letting things into their lives until they are fully taken over by their possessions; video games, whose intermittent rewards structure pings our pleasure centers; and compulsive do-gooders, who will put themselves and their families in danger in order to be perceived as a good person.
In conversation with Begley, she breaks down why we try not to "step on cracks" when we know it won't "break our mother's back," how your social-media use is not a mental disorder, and psychiatry's history of over-labeling relatively normal behavior.
Courtney E. Smith: We often throw the terms around interchangeably, but what are the differences between compulsive behavior, obsessive-compulsive disorder (OCD), and obsessive-compulsive personality disorder (OCPD)?
Sharon Begley: I started out with the same question, wondering what counts as compulsive behavior and how you can tell the difference between that and an impulse-control problem or an addictive behavior. The American Psychiatric Association, in its current Diagnostic Manual (DSM-5), for the first time allowed a behavior to be considered an addiction with gambling. That means that suddenly behavior can be either addictive, impulsive, or compulsive. My first round of interviews for this book was asking psychologists, psychiatrists, and experts to explain to me the difference. Long story short: they struggled to explain it.
A compulsive behavior is one that is born in anxiety; in other words, we feel anxious about doing or not doing something and then engage in that behavior to make the anxiety go away. That connects with OCD, which is a well-recognized disorder. It is characterized by obsessions and compulsions. The obsession is an idea in your head, usually an incorrect idea, about the world, like thinking your hands are covered in germs or that you've left the front door unlocked. The compulsion is the behavior that you do to diffuse your anxiety. A person with OCD will wash their hands all the time or get up countless times during the night to check the door lock. It can be completely and totally debilitating. OCPD is a recognized disorder, in the DSM-5, that is characterized by obsessive thoughts that aren't quite as severe as OCD. It is an extreme form of consciousness.
CES: An idea you put forward in the book that caught my attention, because I hadn't previously given much thought to the difference between compulsion and diagnosed disorders, is that we should think of compulsion on a spectrum, in the same way we talk about autism.
SB: That surprised me, too, because we all know people who are a little bit "that way," but there are also people who are so much "that way" that they can barely leave their homes. What I found interesting was that there are degrees of compulsion that are not diagnosable, they do not qualify as mental disorders. The disqualifying element of them is that to be a mental disorder, it has to cause distress and impairment. There are people who have compulsions who are totally functional, sometimes super-functional. One of the most interesting ideas, to me, is that compulsions can be adaptive — meaning they are a way of coping with the world and what it throws at you.
Some forms of compulsion are not only socially acceptable but socially rewarded. [For example], if you're a housewife and your home is immaculate, you might be rewarded for it. Being super-organized at work is also something that's rewarded and accepted.
Living with the possibility that you might miss something, whether it has to do with your work or relationships, is very hard for more and more of us to do … so we check.
CES: You tie the idea of compulsive use of social media in the book ultimately to a human need to avoid death and loneliness. It makes it seem like more of an affirmation of humanity rather than a compulsive behavior, which we've all read that our desire to constantly log on to Facebook, Instagram, Twitter, Snapchat, whatever, is. Can it be both?
SB: For some people, it can be both, but for others, it is one or the other — it's impossible to make a generalization. All these amazing new forms of technology and social media fill different needs for different people. To me, the reason it fit with the overall idea of compulsions is when we can't stop looking at it. When we have to check. The major driver for that is fear of missing out, FOMO. You take half a second to check and see if you have a text, or another cool post on Facebook. It's no effort at all. Living with the possibility that you might miss something, whether it has to do with your work or relationships, is very hard for more and more of us to do … so we check. We check when we wake up in the morning and keep checking. We check at the dinner table with people.
The life-affirming part of it, that's how some of us connect. Connection is so central to our self-identities and sense of where we belong in the world.
CES: Does the way the mental-health community thinks about this shift as mass culture embraces it, as everyone starts using it? It seems like a majority of people have at least a mild compulsion to check their social feeds, so can it still be called compulsive behavior?
SB: These technologies aren't that old, but they still have a history even if that is only plus or minus ten years. It was quite interesting and funny to see how psychiatrists and psychologists, most of whom are older white guys, not to put too fine a point on it, were recording the rise of new media. Oh my God, you could just see them sitting there, pulling their hair and wringing their hands as they wondered what these young people are doing and assuming it's a form of mental illness. Suddenly, once the old white guys also start doing it, it's no longer a mental disorder [laughs]. Not to be completely flip — psychiatry has had decades of problems with over labeling things, [but] it's become attuned to that predilection and, to its credit, has become more circumspect before it starts labeling behaviors. If a huge fraction of the population is doing something, you can't call that mental illness. That's not the way things work.
This interview has been condensed and edited.
Courtney E. Smith is a freelance writer based in Texas and the author of Record Collecting for Girls.