Are you crazy enough to succeed?

Living with the uncertainty
Vladimir Coric, M.D., an associate clinical professor of psychiatry at Yale medical school, runs Yale's OCD research clinic.

He believes that "having some obsessive-compulsive traits can be adaptive in some circumstances and contribute to one's success. If you don't worry about the expectations of your boss and the details of your job, you could be fired. It's appropriate to be obsessive and compulsive about important things. If you're able to turn it on and off, it can be a highly adaptive personality trait. If you're not able to turn it off, as with OCD, it can be highly incapacitating."

Preoccupation with detail is like blood pressure: Too much is bad, as is too little.

Most anxiety disorders tend to skew female. Not so for OCD. Men make up 50 percent of the OCD population and, like me, they tend to develop symptoms earlier in life than women do. And given men's propensity to deny mental disorders, the numbers are probably higher.

But obsessions don't control me anymore. Thanks to chemistry, I've evicted the gnome who forever walked the same path in my mind. The rut he wore has grown over, and my attention no longer sinks into his steps. Still, I've carefully husbanded the obsessive-compulsive traits I like — just enough perfectionism on just the right things, plus a healthy dose of anxiety about my performance and how it is viewed. I rely on them to this day.

Of course, I'm one of the lucky ones. I was able to get help, and then pay for it. Whether others will be as fortunate is now being debated in Congress.

Insurance coverage for mental health improved in the wake of the 1996 Mental Health Parity Act. This federal law mandates that the dollar limits set on health-care coverage for psychological problems equal the limits for problems elsewhere in our bodies. But insurers found plenty of loopholes.

Peter Newbould, the director of congressional and political affairs for the American Psychological Association Practice Organization, says he knows the system still isn't working. "If you've visited your general-practice physician about your backache, and he or she refers you to a chiropractor or orthopedic surgeon, you may pay just 20 percent," he says. The coverage for mental disorders is not nearly as generous. "The system has been rigged for many years in a way that disadvantages mental health," Newbould says.

This is especially true for OCD because it isn't a pop-a-pill kind of condition. Effective treatment for even a mild case requires multiple visits with a specially trained therapist. The good people at Your Insurance Company are delighted to reimburse you for these visits, usually up to a total of, ahem, 50 percent of the cost. Oh, and please don't exceed your maximum visits for the year — as few as 20. If you do undergo enough therapy to get better, the bills will drive you crazy all over again.

Help may be on the way. In Congress, Sen. Pete Domenici (R-NM), an architect of the 1996 law, has teamed up with Sen. Ted Kennedy (D-MA) to pass the Mental Health Parity Act of 2007, which is now the topic of compromise discussions between the House and Senate. "It is a matter of fundamental fairness that illnesses of the brain are treated on par with other illnesses like cancer, diabetes, and heart disease," says Domenici, who's retiring this year. With any luck, he'll go out with a parity party.

At the end of my day at the institute, I sat with Szymanski, disturbing the feng shui of his neat (obsessively neat, you might say) office. "Here we have patients write their own eulogies. The idea is to project yourself into the future to answer the question, 'What do I want my life to stand for?' People say, 'I want to contribute to the community.' 'I want to be a good person.' 'I want to be connected to my family.' Right, and you spent 4 hours in the bathroom reshaving yourself. How is that connected to your goal?"

By focusing on their lives instead of their anxieties, patients at OCDI learn to live with the sort of uncertainty that used to cripple them. Jonathan is 31 now, 18 years into a battle with OCD that has cost him nearly everything. He is disabled, but perhaps not for long. Three weeks into his stay, he can envision a better future: "I am a highly motivated person, and I function at a very high level even with the severe OCD. So with these tools I'm learning, the sky's the limit. Right now, I'm trying to figure out which parts are the OCD and which parts are me."

An OCD to-do list: Find therapy, or else!

One in 100 adult Americans has obsessive-compulsive disorder. "Affected people can be normal in every way except this one thing that's totally nuts, and they know it's totally nuts," says Michael Jenike, M.D., medical director of the Obsessive Compulsive Disorders Institute at Harvard University's McLean Hospital.

Sound familiar? The Obsessive Compulsive Foundation recommends finding a therapist who is oriented toward behavioral or cognitive behavioral therapy — ideally, one experienced in a practice called exposure and response prevention (ERP). In this kind of treatment, a patient is exposed to a feared situation, but then refrains from performing the compulsive ritual in response. The therapist should be able to teach you to practice this on your own, as well as introduce you to effective drugs, such as Prozac, Celexa, Lexapro, and Zoloft.

For all that, be prepared for a long haul: It takes an average of 17 years to receive effective treatment.

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