Looking at the World Through Paxil-Colored Glasses

Okay.

I hung up the phone, buoyant with relief, walked into the bathroom to fool with my hair, dropped the comb and watched it bounce and land in a funky corner far behind a radiator. I reached down slowly, picked it up, rinsed it off and thought, "Now I have leukemia."

The only things that assuaged the anxiety were rituals. Mine changed over the years as my bad thoughts shifted focus from my own well-being to thoughts of harming others. Nothing was safe for me; perhaps it is more accurate to say it seemed that nothing was safe from me. I feared that my thoughts might make planes crash, babies die and buildings burn. That I knew they could not was irrelevant. I was compelled to negate the thoughts somehow to prove I did not mean them. Sometimes I had to shake my head "no" when I thought no one was looking, or find the word "no" or the letters N and O in my surroundings or in whatever I was reading at the time. More commonly, the rituals involved touching and retouching objects, even retrieving things thrown into the trash. Later they changed exclusively to ruminations, thinking and rethinking, erecting great teetering ziggurats of thought. They consisted of syllables that meant everything to me, and I dared not drop even one, like a stitch, that would unravel my progress.

"I-never-denied-had-gave-or-did-any-of-those-horrible-things-I-won't-I'm-not-Mimi-is-my-name-God-forbid-Mimi-is-my-name-thank-God." I have said those words, and words like them, over and over in a vain to attempt to trap my thoughts in a box, to contain them, to stop them; I have said these negations so many times that they have become a part of my heartbeat.

They have never worked for long.

The less effective the negations became, the most intricate they grew. The more intricate they grew, the less sure I was that I was thinking them correctly. At some point I started saying them aloud. I was talking to myself. As you can imagine, it was dicey to say them when I was in public, and downright dangerous when I was driving a car. My compulsion was to establish -- to whom? to God? to posterity? to myself? -- that I was good, that I did not mean what was going through my mind. There was an Animals song that was popular when I was in high school whose lyrics became my mantra:

"I'm just a soul whose intentions are good/Oh Lord, please don't let me be misunderstood."

Just walking down the hall at school and humming that song became a surreptitious way to appease my need for expiation. It was certainly better than some of my other compulsions: During several weeks in 10th grade, the only thing that felt right to prove my innocence was to reach out of the shower while washing my hair and touch the bathroom socket with my sudsy hand, a compulsion that got shocked out of me one very, very lucky night.

I had no idea what was wrong with me until the year after college, when I shared my first apartment in New York with a college friend who was getting a master's of social work at Columbia University. I had my first real job, as assistant to the senior editor at Glamour magazine, and one of my chief responsibilities was typing form rejection letters. After a month or so, I became seized with the fear that I was typing obscenities into the letters. Checking them did not help because I did not trust what I read. I dreaded work and started to call in sick. When I could no longer keep my suffering to myself, I confided in my friend. She knew exactly what was going on.

Once she told me about OCD, I felt elated and amazed. It was inconceivable to me that anyone else had ever suffered such bizarre behavior, and having a name for it gave me hope. That year, I started psychotherapy. The symptoms did not stop altogether, but I was able to manage my illness most of the time. When the rare breakdown occurred, I'd stitch myself back together with more frequent therapy and a little Valium, and only my closest friends would be the wiser. By the late 1980s, however, I felt I had gotten the most I could out of talk therapy. My files of recollection had been emptied, my mind hosed down. I felt well enough to coast between what I considered 5,000-mile checkups with my therapist. Then came the spiral in New York on New Year's Eve.

I began taking Paxil at an advantageous time. By 1994, my marriage was unraveling, and my mother was exhibiting sudden signs of dementia. In 1997, as it became clear that my marriage was over, my mother had three hip-replacement surgeries, I lost my job in a corporate purge and, with a year's severance as a net, I decided to try becoming a writer. Stress had always caused an uptick in my symptoms; had I not been stabilized on Paxil, I might have gone to pieces.

My weight gain had become a constant topic of sessions with Ramsey, but I had made my choice early on: I did not like being plump, but it certainly beat feeling crazy. I tried a reduction in dosage and, later, a new, time-released version of the drug. Neither reduced my jones for sweets. Around 2000, I developed tremors in my hands and occasional involuntary jerking motions in my arms and legs, a side effect attributed to some SSRIs, including Paxil. Once Ramsey assured me that they were benign and not a sign of brain disease, they did not matter to me. Living with tremors, like being overweight, was a fair trade-off for the silence in my mind.