Compulsions take many forms. Some of us feel like we must document our every outing on Instagram Stories—a compulsive urge, sure, but not a life-disrupting one. Others, like the people who populate Sharon Begley's book Can't Just Stop: An Investigation of Compulsions, have compulsions that throw a monkey wrench into daily life, making the mere act of throwing out an old ATM receipt feel like forever losing a cherished memory.
Begley, who works as a science journalist for the website Stat, empathetically portrays a range of compulsive people in her book, including those who can't stop playing Candy Crush, writing in their diaries, collecting old boxes, shopping for superfluous clothes, and pulling out their own hair. In some cases, the therapy offered to sufferers of these debilitating compulsions can be cruel, like the germaphobe forced to touch toilet bowls in public bathrooms as part of his exposure therapy, or the hoarder instructed to throw out everything that's connected to her past.
There is a less painful way out of compulsive behavior, but it involves shouting down a seductive inner voice—an "interloper," as Begley puts it, who tells the afflicted that they have to avoid cracks in the sidewalk or else something terrible will happen to a loved one. "They have to recognize that there's a problem with their wiring and that it's telling them a lie," Begley told me.
While, according to behavioral archaeologists, compulsions were once thought to be caused by Satan, today we know that they're often born out of an ambiguous sense of dread—a feeling that's in abundance these days. Begley argues we shouldn't rush to pathologize everything we do in response to this feeling. (Unless, of course, we're destroying our lives.)
I talked to Begley about what compulsions look like inside our brains, why we'll always be hooked by stupid games on our phones, and what is going on with our president's compulsive tweeting.
BROADLY: How does compulsion work inside our brains, and how does it differ from addiction?
Sharon Begley: Whenever you read accounts of the brain's pleasure chemicals, they tend to come from research performed back in the 50s, in which rats who'd had their dopamine circuits activated would keep hitting a little lever that activated their dopamine region—so much so that they wouldn't eat, wouldn't sleep, wouldn't do anything they needed to do in their lives. People said, "Oh! Dopamine is pleasurable. They're addicted to pleasure!" But what's emerged in the last few years is that the dopamine circuitry actually predicts how much you will like something and how much pleasure it will give you. Then it calculates how much reality corresponds to the prediction or falls short. The emerging idea seems to be that when reality falls short, we feel a dopamine plunge. That feels bad, so we keep trying to do something that will make reality live up to expectations. That, to me, fits in with compulsions because these things we're doing really aren't that pleasurable. Rather, it's the dopamine fuel, pleasure, and reward circuit that's making us feel bad.
You write that this plays out in video games, right? You're hooked not because of the dopamine rush you get from destroying the pig's house in Angry Birds, but rather your anticipation of how it will be destroyed?
Exactly. It doesn't, for many people, feel as good as you'd expect. So you think, OK, well, I should try to destroy another pig's house, because that will finally make me feel better. And because it doesn't live up to our expectations, we feel driven and compelled to keep trying, like one of these days it's going to feel great. If it never does, then you're in this essentially infinite dopamine loop.
And you say the gaming industry feels ambivalence about their god-like power over people's dopamine.
Yeah, they call it digital crack. There's a whole debate in the tech community about what their ethical obligations are; they feel bad about making people hooked. Can't a game just be enjoyable and not have this pernicious effect by drawing on how the brain works?
How terrible would it be if I didn't read the text right away?
How can we be less compulsive than technology wants us to be?
If you recognize the source of the anxiety that is making you do this, then you can ask yourself: How terrible would it be if I didn't read the text right away? How terrible would it be if I looked at all the texts or emails in an hour, or in two hours, or at the end of the day?
[In] exposure-and-response prevention (which we don't like, but I'm going to use the analogy anyway), the therapist might say, "Just touch this door or doorknob [that you're afraid of touching]." With digital detox, just go one night without sleeping with your cell phone. Then try not turning it on first thing in the morning. Convince yourself that you can stay away for a little bit of time, and then a little bit more time, and then maybe even entire dinners with friends or families.
Of all the people that you profiled, which story stuck with you the most?
One of the women who hoards really affected me. She has five children, but she lost seven others from miscarriages, and her husband abused her. (She's now a widow.) She would look in magazines for pretty window treatments or gazebos to build, and they never had the money to do any of this. The only presents her husband bought her were cardboard boxes. So she kept the boxes. If you keep enough boxes, sometimes they start to fill your living room and garage and basement and attic. But that's all she ever had from him. Similarly, she never had the opportunity to make her house beautiful or go on lovely vacations, so she kept all her clippings from the newspapers and magazines she read—she never had the real things, all she had were her dreams. She told me she became attached to the pieces of paper, and now all she has is the paper, so she can't bear to get rid of it.
That's a feeling a lot of us have had—not as extreme as her case, but we all have stuff from the past that would break our hearts to get rid of. People who hoard have exactly those emotions, but their emotions are attached to a lot more things. They are not different to us in kind; only in degree.
Is there any strain of research into compulsions that has come closest to cracking how we can treat them?
This is one of those things where money talks. Unless it's in the Diagnostic and Statistical Manual of Mental Disorders (DSM), insurance companies will not pay for treatment. So [according to them], there's no such thing as compulsive shopping or internet abuse disorder—there's only OCD, hoarding, and a couple of others. The hope is that the research on those disorders will translate to milder compulsions and compulsions that have not yet been recognized. A form of cognitive behavior therapy can help, and that at least holds out the hope that something similar might work for people who are struggling with even milder compulsions, if they want that help. If it's not affecting your life in a negative way, though, maybe it just makes you a more interesting person.
Trump's Twitter account has been the subject of endless, often annoying, media coverage, but I just have to ask: Do you think the president is compulsively tweeting to resolve some kind of anxiety?
By most measures, he's not impaired. However, I spoke to a number of psychologists and psychiatrists about his tweeting, and one of the things that jumped out at people is that he seems to have a huge amount of difficulty accepting what one psychologist called a "less-than" feeling. He cannot stand the possibility that he is not the smartest guy in the room—the greatest, most powerful, the superlative in every way. When he feels inferior for whatever reason—perhaps because he's comparing his inauguration crowds to the Women's March crowds—that seems to spur some anxiety in him, and it might compel his tweeting. He may alleviate his anxiety 140 characters at a time.