My Brother's Keeper" Chapter Seven: "You Want What?" Epilogue Author's Note Acknowledgments Bibliography Notes Index This is for Dr. John M. Kramer. Your dedication and leadership in the treatment of OCD has helped thousands of patients and families, and your influence will continue to improve and change the future of mental health. # Introduction It's late afternoon on March 26, 1988. The temperature hovers in the low forties, but my body is warm. There are no sweat glands, so I feel nothing as I walk to the front of the gym to be weighed. I turn and start back toward the locker room, watching the people going by. _They look different. So slow. It must be the cold weather._ I see them again as I walk down a side hallway to the restroom. They don't look different to me now. They are still moving slowly, their steps halting, as they make their way to the sink. _Their faces are strange. Have they gotten thinner or bigger? Is it just the cold that makes them look this way?_ I think of my parents and how they'll react when I walk into their room and don't look like I should. They'll scream at me. _What's wrong with you, Robert? You have this problem. Don't you know you look like that? Don't you realize what this will do to our reputation? Don't you understand that your poor sisters have to do the same things, the same workouts, day in and day out?_ I have a sudden realization that all of this—the way I look, the thought that I am in some way defective—is _wrong_. It's _really_ wrong. I _know_ it's wrong. I'm a scientist. It is a fact that certain kinds of thoughts can be false. If that's the case, then it follows that this _is_ false. But that thought isn't there now. I'm standing in the bathroom, next to the sink, alone, a single stream of ice-cold water pouring over my hands. _Why did I need to wash my hands again? I washed them on the way here. Twice_. I know that my brain hasn't changed. I know that I haven't changed. I know that _I know_ that I know. I look at my hands. They are swollen and red from the cold, and now they're all shriveled and wrinkly. It is a kind of pleasure to look at them this way. They look like they belong to someone else. They look like they belong to a disgusting woman who wears sweatpants in public. I leave the room. My mother is waiting for me in the hallway. She grabs my arm. "What are you doing?" she screams. "Get out of here! Go back to the shower room!" I am in the shower room. I leave the shower running and sit on the bathroom floor. I cry. _I've been bad again. I'm disgusting. They don't want me around. They never want to see me again_. _I should just kill myself. Why don't I kill myself?_ _I am a scientist. It is a fact that certain kinds of thoughts can be false. If that's the case, then it follows that this is false_. I'm going to get help. I'm going to go to the psychiatric clinic, then to the research hospital, and see how this disease works. I need to know. _There has to be a way to make my body stop going on like this, one that will make it possible for me to think normal thoughts again_. This kind of thought didn't make it out of the shower room. I have another. This one is a thought I've been having for a long time. _No one can help me. Nobody knows how to help me. I am so alone. I should kill myself_. This thought is very different from the one about killing myself. This is a thought about myself. _I need to learn what my mind is doing in order to stop it_. I'll be a scientist, too. I'll find a way to change it, to make it more pleasant for me, so that I can go through life like other people. I begin the process of applying for a grant to help pay for a research fellowship at Yale Medical School. I also see an appointment at the Johns Hopkins University School of Medicine, where I was a student when this all began, and where I believe I will find more help in overcoming the disease. When I hear that everyone there knows about my disease, I decide I'll not tell them about my past. I'll hide my past in my face. I'll wear my hair long and comb it straight back. I'll always wear one of my three black shirts, the white one, and the blue, gray, or black tie. I'll let everyone see the black shirt, so they'll never ask me about it. The blue shirt will be too big, too loose. I'll button it one hole below the bottom, where it doesn't show, so that no one will notice my hands shaking, my hands that are shaking because I am thinking terrible thoughts. The blue shirt is perfect, because it will make them think I am calm and good and not crazy, at least not so crazy. The other one, the gray one, is the same size and shape as the blue one, but is gray and light and a little thin and faded, not very attractive at all. It might cause people to question my appearance. They might be less likely to make the mistake of thinking I don't care about clothes or grooming. I know what to do about the gray shirt. I'll wear it until I'm ready to take it off. It will be my insurance policy for staying alive. I tell a friend that I'm doing some research at the medical school. "You have to come with me," I say. "I'll pay for it. There are many other people with OCD. It would be good for them." I pay a lot of money for a hotel, though it's not fancy, not a place where I think anyone would go to party. My friend and I sit on the bed in our room and I look around. The bathroom is empty, the shower stall and room without an entryway, the door closed. A desk and chair are in the middle of the room, a chair with a seat padded with an American flag on it. The floor is covered by a thin sheet of carpet. The sheets on the twin beds are white and crisp. We sit and wait for the elevator. I wonder where they will put the trash. "No," he says. "It is too expensive." My friend drives me to my car, and I am glad. My hands don't shake when I'm driving, and I know where to go. It will be easy to find the psychiatric clinic, and I'll feel good, like I'm in control. I'm not. I'm being pulled by a current, with no real control over where I'll go. I walk into the meeting with the doctor with hair like a television advertisement and with a big smile on her face. She smiles at me and shakes my hand, and I don't notice that she has a blue mark on her thumb, the mark of a ring. "Hi," she says. "I'm Dr. Peebles. Let's have a look at you." I show her my medical records from New York, show her all the letters from all of the places I've gone since I was a child. I show her the list of symptoms that I had in New York—the same list I have here, in the beginning. She looks at me with a big smile, nodding, smiling. She knows this is all normal and has happened to everyone who comes to her. She pats my hand and leaves the room. She's gone for fifteen minutes, and I sit in the waiting room. I see my reflection in a mirror. It seems like someone else is in this room with me, someone who smiles and laughs and says nothing. The man behind me is watching a football game on the television and asking me about my son, who is a freshman at the University of North Carolina. "He plays college ball, the same as you," he says. "He plays for us, right? At UNC?" I've never met him before. I nod. He shakes my hand. He says he wishes I had been his psychiatrist at the time he was seeing the first doctors. "I think I would have made it. I don't know how long I would have been in denial, or how long it would have taken me to get the right help, but I'm sure it would have been a lot faster. You're just doing this." He's got a big smile on his face, and it's nice to hear. The light outside the windows is bright. The sky is a blue color that doesn't exist at home. There is a little bit of green in the grass around the building, and the trees in the back yard are a dark green. Dr. Peebles calls me into her office. "You have a family member who has OCD," she says. "You probably know that most of our patients are parents, because they tell us. They are the most