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Book Review - Because We Are Bad: OCD and a Girl Lost in Thought

09/05/2016 21:25 | Updated 09 May 2016

If you met Lily Bailey through either of her current professions, you would be unlikely to imagine the incredible distress that has plagued her from early childhood. An accomplished journalist with a caustic wit and successful model, many would feel intimidated - perhaps even envious.

A scholarship to a public school, entering Trinity College Dublin's prestigious English degree after a gap year - a charmed life? Her new book, describing the impact of obsessive-compulsive disorder (OCD) on her life, suggests that this is far from the case.

Because We Are Bad is a harrowing account of a girl's struggle to make sense of the world and contend with distressing thoughts and perceptions that constantly tore into her mind and life. A complex silent battle being fought day and night for many years, while trying desperately to fit in without betraying her secrets and the world coming crashing down.

Often as chilling as Sylvia Plath's The Bell Jar, but also full of so much inner and external turbulence that it reminded me at times of The Bourne Identity and Memento. Readers will root for Lily, even when she is attempting to run away from the realities - and sometimes authorities - chasing her.

Lily's account of her OCD allows the reader to see exactly how obsessions can take over and ritualistic compulsions be created in an attempt to keep a chaotic reality in check. Compulsions which, ultimately, add to the anxiety rather than vanquish it.

Some compulsions can be apparent to the untrained eye, such as excessive hand-washing - which can leave skin red raw. Lily says that hand-washing, locking doors and turning switches off were "the visible tip of an otherwise fully-submerged iceberg". The vast majority of her compulsions were invisible to others. The most significant of these was making mental lists of things she was obsessing over - things that made her 'bad'. Each word would subsequently be reduced to a letter, which then became part of a vast cascade of letters - frequently exceeding a hundred a day by the time she got help. Each morning when she woke, the letters and words flooded her mind, quickly joined by new ones.

Lily's condition was complicated by having a second self within her mind constantly battling to ensure that the obsessions and compulsions took primacy over everything else in life. This bullying aspect of herself, which she missed after effective cognitive behavioural therapy drove 'Her' out, came into being at a developmental stage where imaginary friends are common. This particular 'friend', however, appears to have become the embodiment of OCD.

Overt compulsions Lily learned to hide from her family and friends included a complex sequence of hand and foot movements, which her dad described as "fidgeting". She consequently made them so subtle that people would be oblivious to them. She was also preoccupied with her younger sister dying at night. Consequently she would, after carrying out a sequence of rituals in her own room, including prayers said in sequences of three (or nine if done imperfectly), creep into her sister's room to check her breathing and heartbeat.

With the weight of the world on her shoulders, Lily managed to live in the world of her family and schools while having a secret world in which she constantly fought, documented and ruminated upon negative thoughts.

Lily's account goes from early childhood to age 21, through time working in childcare in the UK and abroad, university, periods in mental health units and managing to move into journalism. Amid the apparent chaos of the letters Lily was compelled to go over and over every day, the reader will see connections between the culture she grew up in and the obsessions that plagued her. For example, when remembering how her hand-washing rituals started, she recalls a TV advert where "dirt is seen in ultraviolet light, infecting everywhere", yet the product advertised only killed 99.9% of the germs. "WHAT ABOUT THE OTHERS?" little Lily had silently screamed.

There is not only logic in Lily's elaborate system, but there are also links between her early trauma, what she feared the most and the darkest thoughts that followed her into adulthood. Fortunately she was able to tell a specialist about her lists, much to the anger of her other self (who insisted to Lily that the lists were the solution to life's problems), and accept treatment. This wasn't a smooth process but a turbulent journey, with the illness constantly recoiling against treatment, as though it was an actual person fighting a tug of war over Lily.

The 'Her' Lily talks of has gone now and Lily attends a regular support group, which she has found incredibly helpful. Reluctant to attend initially, after hearing other people's accounts in the group she felt like she had "come home."

Because We Are Bad is an intense heart-rending roller coaster of a book, and it would make a powerful screenplay. Lily's story will support other sufferers and help those close to them to understand what is happening beneath the surface. As a clinician and when studying medical anthropology I read many illness narrative books. Because We Are Bad is the most engaging and well-written account of mental health experiences I have read and should be on the reading lists of courses for mental health professionals.

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