Scott Stossel, the editor of The Atlantic magazine, is the author of “My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind.”

Lily Bailey is precocious.

If my math is right, she has published this, the American version of her remarkable first book, in her early 20s, just five years removed from her most recent stay in a London psychiatric hospital, at age 19, for severe obsessive-compulsive disorder (OCD). She writes with literary poise and a gift for mordant observation and self-deprecating humor that belie her youth.

But her precocity extends, unhappily for her, beyond writing talent to the devastatingly young age at which she developed her mental illness, which had reached its full dreadful bloom by the time she was a schoolgirl. “It’s been a very long time since I saw someone so young with OCD as progressed as yours,” she’s told by the psychiatrist, Rachel Finch, who provides Bailey with her first proper diagnosis.

Pop-culture renditions of OCD tend to depict it as an almost charming but not devastating condition. Think of Tony Shalhoub’s character on the TV show “Monk,” whose OCD — which was mainly played for humor — helped him solve crimes, or Jack Nicholson’s curmudgeonly, OCD-ridden novelist in the 1997 romantic comedy “As Good as It Gets.” Today, the most common idiomatic, nonclinical invocations of the disorder make it sound benign, if not almost salubrious: “I’m so OCD,” people say, humble-braggingly, to refer to a general predilection for order and cleanliness.

Bailey makes clear that the feeling of living with the disorder is not benign, and her greatest achievement with this book is to vividly depict the hellscape of a mind ravaged by severe OCD. Here’s an abbreviated litany of what Bailey endures before she even reaches high school: the inability to go to sleep unless her mother recites a certain precise liturgy of sentences (I had this problem as a child, too — and in fact the sentences I required were uncannily similar to the ones Bailey needed); the completely irrational belief that she was responsible for the death of her cousin Tom (“because we are bad”); the exhausting rituals and incantations she believes she must perform every single night to keep her (completely healthy) younger sister, Ella, from dying; the tapping and counting and retapping and recounting and re-re-tapping and re-re-counting; the incessant germ-phobic scrubbing (50 times or more per day) that leaves her hands a painful, bloody mess; her inability to countenance any (self-perceived) imperfection in her comportment or performance without days of lacerating self-criticism.

And this, believe it or not, is the mild stuff. In boarding school, in order to function, Bailey develops a set of “routines,” as she calls them, that are astonishingly byzantine and time-consuming. She spends several chapters describing them in their torturous elaborateness, so it’s hard to do justice to them here, but in essence what she does is this: She assigns a letter and a color to every worry that arises throughout the day — sometimes dozens of them — which she then memorizes and subsequently has to assess and resolve in her mind individually, a process that can take four hours or more every night. Bailey is a good student — a “clever” one, as the Brits say — but she ends up having to take exams among the cognitively slow because she has to fully resolve her “routine” before beginning any test.

About this period, Bailey writes, and no wonder:

“We are.



“We”? In the early part of the book, Bailey deploys an unusual and mostly effective, though occasionally confusing, literary device, referring to herself in the first-person plural. Actually, this is not a purely literary device, because she’s not referring only to herself: She’s writing from the perspective of both herself and the imaginary friend who lives in her head, ostensibly to keep her safe, the anthropomorphized avatar of her OCD. “There are two of me in my head,” she tells Finch, who eventually — through medication and cognitive-behavioral therapy — helps Bailey banish her “friend” from her brain.

In the second half of the book, Bailey takes us through the remainder of her school years, including an unsuccessful suicide attempt (“I have failed. I couldn’t even get this right”), several sojourns in different psychiatric hospitals, partial remissions, a break-up and reconciliation with the heroic Finch, a trip to Thailand, and a job at a nursery (where her OCD makes her terrified that she will be accused, wrongly, of pedophilia). Along the way, she makes gimlet-eyed observations about schoolgirl culture and the British class system.

The book is almost entirely narrative-driven, with the only scientific exposition of OCD provided by Finch in her sessions with Bailey; for the most part, the reader lives with Bailey in the prison of her OCD-ridden mind. This makes the book one of the best I have read on the phenomenology of OCD.

As good as the book is, the ending is frustratingly peremptory. Bailey separates once again from the kindly Finch and suggests, rather unconvincingly, that she is more or less cured (“I am better,” though she’s vague about precisely how much better, or how she got better), finally free of the mental prison that she has lived in for two decades. Skeptical about this, I ventured a quick Google search and found that Bailey has signed on as a writer for Psychology Today, on whose website she recently published an item titled “Recovery From Mental Illness Isn’t Always Linear,” in which she recounts, as the headline suggests, that while she indeed is much better, she is not wholly free of her obsessions and compulsions, which can still flare up. This adds important nuance to her book, and aligns with what the epidemiological evidence shows about OCD and other forms of mental illness (many people improve, or achieve temporary remission, without being fully “cured”) and which is certainly true of my own experience of anxiety and mental illness. (Of course, some people do achieve complete and permanent recovery.)

Despite some jarring writerly missteps — a few dream sequences, presented in hackneyed fashion; that abrupt ending — the overall effect the book has on the reader is, first, one of overwhelming sympathy for the author, who has endured years of emotional torture perpetrated by her own mind. I hope this book finds a wide readership: It will offer solace to OCD sufferers who will understand that they are not alone and who might gain hope of remission; for other readers, it will provide a harrowing sense of what many OCD sufferers have to endure just to get through the day.

Because We Are Bad

OCD and a Girl Lost in Thought

By Lily Bailey

Harper. 257 pp. $26.99