“Right. Ritualistic behaviors.”
“Yes.” Max nodded, jittery. “Once at work, I slipped and said the ritual words out loud and my boss heard, which was terrible.”
Eric didn’t interrupt, but typed a note, work?
“Nobody knows, not even Gummy—I mean, my grandmother.” Max knit his hands, his expression showing the strain. “It’s horrible, like, a secret I keep. I feel kind of crazy, and nobody knows, like, I have a double life.”
“I understand. Tell me when the rituals started.” Eric knew exactly how Max felt, though he wouldn’t tell him that he’d had an anxiety disorder, yet. Eric used to question how he had the right to treat anybody when he’d had a mental disorder of his own, but every one of his colleagues had something, and people became psychiatrists for a reason. In truth, he believed his old anxiety disorder gave him insight he wouldn’t otherwise have.
“A few years ago, maybe two years ago, it got worse. Really bad. I have to touch my head, my right temple, one time, right on time. Every fifteen minutes.”
“Around the clock, you mean?”
“Yes, if I’m awake, every fifteen minutes, I have to do this.” Max demonstrated, tapping his temple with a slim index finger. “I can’t do it too late. I hide it at school or at work by pretending I’m moving my hair or touching a zit or something.”
“So you have to watch the clock.”
“Yes, constantly. I count down the minutes sometimes, to get to fifteen. It’s always on my mind. It’s all about the clock, twenty-four/seven.”
Eric could imagine how hellish it would be. “Do you count anything else?”
“Like what?”
“Ceiling tiles, sidewalk blocks, the number of times you chew, for example?”
“No.”
“Do you do things in numbers, like everything you have to do, you do three times?”
“No.” Max shook his head.
“Do you have to even up things, like make something symmetrical?”
“No.”
Eric took notes. “What certain words do you have to say when you tap?”
“I have to say red-orange-yellow-green-blue-purple-brown-black, all at once, fast.” Max recited the colors together, in a rush. “I have to keep an eye on the clock and make sure I do it right on time. It drives me crazy.”
“I’m sure. Is there any significance to the colors?”
“I don’t know.” Max paused. “But the picture in my head is watercolor paints I used to have when I was a kid, you know the kind everybody has, the lid flops open and there’s wells for the paint, with a crappy brush that all the hair falls out of, like eyelashes.”
“I remember.” Eric did. Hannah had one, too.
“That just comes into my head and I have to say it.”
“Why every fifteen minutes, do you know?”
“No, just that fifteen is a good number. I love numbers. I like fifteen, as a number.” Max shrugged unhappily, his narrow shoulders going up and down in the T-shirt. “I hated turning sixteen because I had to leave fifteen.”
Eric made a note. “Did something good happen to you when you were fifteen?”
“No, not at all.”
“Did anything happen that could have precipitated these rituals?”
“No.” Max shook his head, nonplussed.
“Your grandmother’s diagnosis was about two years ago, wasn’t it? You told me so last night.”
Max blinked. “Yes, that’s true.”
“So that was when you were fifteen.”
“Right. Does that make a difference?”
“Possibly.” Eric thought it seemed too easy. “Sometimes events like that can trigger or exacerbate OCD symptoms.”
“Oh.” Max’s forehead eased. “So that’s why?”
“No, not there yet.” Eric held up his hand. “Do you have any idea why you do these rituals?”
“No.”
“Does it happen more in the morning or at night?”
“All the time, no matter what, it’s hard to hide. I drop things, like, to hide it. Disguise it. I don’t go out because it’s too hard to hide. Anytime I’m out, it’s harder.” Max’s eyebrows sloped down miserably, his smile vanishing. “I don’t want to do this crap anymore. I can’t keep this up. It’s always on my mind. I watch the clock, I check my phone and my watch, all the time. I want to be normal, like everybody else.”
Eric felt it strike a chord. It reminded him of Hannah, and how Caitlin wanted her to be normal. And himself, back when he was in the throes of his anxiety disorder, how much he wanted to be normal. Normal was the simple wish of everyone with a mental illness. Normal was what everyone else, the worried well, took for granted. Eric had been on both sides of that line, so he knew it was an illusion. “Do you think something will happen to you or someone else if you don’t tap and say the colors?”
“Yes.”
“What would happen if you didn’t?”
“I don’t know, I couldn’t deal, I don’t want to try. I just know I have to.”
Eric made a note. “Does anyone in your family exhibit any tendencies that way?”
Max rolled his eyes. “No, my mom is a slob, she never checks anything.”
“Point of information, it’s a myth that everyone with OCD is neat. For example, hoarders have a form of OCD.” Eric assumed there were issues with Max’s mother, given what he had heard at the hospital, but he didn’t want to change topics.
“Oh, okay, but still, there’s no history of it in my family, that I know. My grandmother, she’s great.” Max smiled briefly. “She’s a total character.”
“She sure is.” Eric smiled back. “Tell me about your relationship to her. It looked like you two were very close.”
“It’s great, she’s great, you saw. I take care of her. Her eyes are bad, so I get her meals, I make them before I go to work in the morning.” Max’s smile vanished again. “I used to when she ate. Now I get her coffee, but she didn’t have that today, like I said.”
Eric made another note. “You said you work. What’s your job?”
“I’m an SAT tutor at PerfectScore. I tutor for the math section of the PSAT, SAT, and Achievement tests.” Max smiled, again briefly. “I got perfect SATs.”
“Really?” Eric allowed a note of admiration to creep into his voice, though he remembered that Max’s grandmother had already told him that. “Where do you go to school?”
“Pioneer High, I’m a rising senior. I’ll probably be salutatorian, and thank God I’m not valedictorian because I could never make a speech, like, in front of everybody.”
“Congratulations.” Eric wasn’t surprised that Max had above-average intelligence, which squared with the OCD profile, but he needed to know more about Max’s family history. “What about during the school year, do you take care of your grandmother, then, too?”
“Same thing, before I leave, every morning. She couldn’t eat normal food for the past few months because of the cancer, so I had to puree it in the blender.” Max made a hand motion, like a blender whirring. “She can’t swallow anything if it doesn’t have thickener in it, not even water. It comes in a packet.”
Eric knew that had to be a burden, remembering how hectic mornings could be at home during the school year. Still, he missed those mornings. “And at night, for dinner?”
“I do it then too.”
“What about your mom? Does she help?”
“Are you kidding?” Resentment flickered through Max’s eyes. “She drinks. She works off and on, but she’s always with her boyfriend. He lives in the city.”
“How about your dad? Is he around?” Eric knew the answer from Max’s grandmother, but he wanted to hear it from Max.
“No.” Max raked his thin hair back with his fingers, his fingernails bitten to the quick. “He left when I was little. He was a drunk, too. I hardly remember him.”
Eric could see it was topsy-turvy, with Max parentified and the parents abdicating their roles. “And no brothe
rs or sisters?”
“No, just me.” Max smiled crookedly. “Red flags, right? Abandonment issues, mother issues, father issues?”
Eric wanted to deflect Max’s tendency to diagnose himself. “Do you drink or use other substances?”
“No.”
Eric met his eye. “You can tell me.”
“Okay, sometimes. I drink a little and I tried weed in a brownie, but I threw up.”
Eric made notes. “You absolutely should not do any drugs or smoke weed, as an OCD sufferer. Do you understand?”
“Okay, chill.” Max’s eyes flared. “I didn’t know that. I mean, it’s practically legal now.”
“It’s not about the law. This is medicine, and the law is behind the science, as usual. Now, tell me about your friends.”
“My what? I don’t have any.” Max chuckled, a huh-huh sound without mirth.
“Acquaintances?” Eric felt a pang for him, but kept his face in a professional mask.
“Not really. I mean, I hardly ever talk to people, IRL.”
“IRL?”
“In real life. I have online friends, I’m a gamer. Hardcore.”
“What do you mean by hardcore? How many hours a day?” Eric remembered Max’s grandmother had mentioned it at the hospital.
“I play a lot.” Max checked his watch.
“How much is a lot? This is a judgment-free zone.”
Max smiled, tightly. “Six hours at night, like, until late.”
Eric made a note, gamer. “Are you in any activities or sports, at school?”
“Do I look like I play any sports?” Max chuckled again, nervously.
“What about activities or clubs?”
“I’m a mathlete. Too bad they don’t have mathletic scholarships, huh?” Max smiled ruefully, and Eric smiled back, trying to hold his eye contact until the boy looked away.
“What is school like for you during the day?”
“What do you mean?”
“What’s it like, a typical day? Are you lonely?”
“I’m on my own, but that’s fine. I like being alone because nobody’s around to see me tapping.”
Eric’s heart went out to him. He knew firsthand how having a mental disorder could be so isolating, and sufferers tended to hide. “Are you bullied?”
“Not really.” Max checked his watch again. “I’m ignored.”
“How so?”
“Like, for example, my Spanish class had a Halloween party and I went as The Invisible Man, like that old movie. Gummy turned me onto it, she loves that movie. Anyway, I put on sunglasses and a trench coat. I wrapped my face in an Ace bandage.” Max gestured around his head. “But nobody noticed. How ironic is that?”
Eric made a mental note, listening. It wasn’t hard to hear the loneliness behind the story. “What about teachers? Do you have a favorite teacher? Or one that you’re close to?”
“No. They’re all okay except my Language Arts teacher, who’s a bitch.” Max’s small hand flew to cover his mouth. “Sorry, can I say that, here?”
“Of course.”
“Anyway, whatever, socially, I’m on my own. There’s nothing more to say about it.”
“If there were nothing more to say about it, I’d be out of business.” Eric was trying to relax him, make him laugh, but Max didn’t. “Let’s go back to how you feel about the way things are, socially.”
“Obviously, I don’t feel great about it, but there’s nothing I can do about it, it’s too late.” Max’s face darkened, and he glanced at his watch. “I think it happened because my house sucked so bad, like when my mom would drink, I didn’t have friends over. And when people have you over, you’re supposed to have them over, and I knew I could never do that, so I avoided everybody. Then in high school everybody got in their group—the jocks, the stoners, the hipsters, the rich kids, the geeks, the black kids, the hot girls, and the slutty girls who think they’re hot. I don’t fit in anywhere, I end up on the outs.”
Eric noted that Max dismissed his own feelings about being isolated, glossing over them in favor of explaining why he got that way. “Is there a gamers’ group?”
“At school? No, that’s online.”
“What about dating? Do you date?”
“No.” Max flushed under his pale skin. “I know a few girls, but I get friend-zoned.”
“Any girl you’re interested in, like a crush or anything?”
“No, not really. I don’t get my hopes up.”
Eric felt another stab of sympathy, then tried a different tack. “Have you ever had thoughts that you would consider gay or bisexual?”
“No, dude!” Max’s eye flared in surprise. “I’m straight!”
Eric remained silent for a moment, waiting. Silence had a lot of uses in psychotherapy, and he sensed that a client like Max would rush to fill it.
“Dr. Parrish, I’m totally not gay.” Max pursed his lips. “You don’t look like you believe me.”
“I do.” Eric saw an opportunity. “Let me be clear. If you tell me something is true, then I’ll believe it. In return, I will never lie to you, ever. And anything you tell me is confidential. This is a safe place for us to talk to each other, to be completely honest, and everything we say stays here. Do you understand?”
“Yes.” Max paused. “Even if my grandmother pays?”
“Correct, and by the way, when you go home, don’t feel as if you have to talk with your grandmother about what we discuss.”
“Okay.” Max swallowed, his Adam’s apple going up and down his skinny throat, like an elevator. “Um, then, there is someone. A girl.”
Eric made a mental note, it was a small triumph. “What’s her name?”
“Renée. Bevilacqua. I see her at work. She goes to a different school, Sacred Heart, but she comes in for tutoring.”
“How long ago did you meet her?”
“A month ago, when she came to tutoring.”
Eric wrote, Renée Bevilacqua. “What do you like about her?”
“Everything.” Max burst into unaccustomed laughter, flushing. “She’s beautiful, she has curly red hair and tons of freckles. I like them even though she feels weird about them. I know because she puts makeup on her face to hide them.” Max’s face lit up, for the first time in the session. “Her eyes are a bright blue, like really bright, and she sucks the tip of her tongue while she thinks. She’s not good at trig but she’s smart, she just has a mental barrier.”
Eric let him talk, just to see him look happy, however briefly, like any other young man in love. “Would you like to ask her out?”
“No!” Max widened his eyes, as if the question were plainly ridiculous. “She has a boyfriend, but I don’t like how he treats her. Like one day she came in and I could tell she had been crying, and I asked her if she was okay, and she said he said something mean to her but she wouldn’t say more.” Max sighed. “How is telling you this going to help me stop tapping? Are you going to give me a prescription or not?”
“First I need to understand more and get to know you better.” Eric thought it did sound like OCD, not an uncommon form. Luckily, it was highly treatable because OCD sufferers had a high degree of insight, in that they knew the disorder they had, and were ego-dystonic, which meant they wanted to be free of the symptoms.
“Like what?”
“Now, the thing about OCD is that the compulsion, in your case, the ritual of counting and tapping, arises as a way to cope with an obsession. Put differently, the ritual provides a relief from the anxiety created by the obsession. So the question is, what’s your obsession?”
Max frowned. “Are you saying Renée’s the obsession?”
“You tell me. Do you think about her a lot? Is she on your mind?”
“Yes, but…” Max looked stricken. “But the thoughts about her, they aren’t good. They’re weird and strange. They, like, disturb me.”
“Obsessive thoughts are rarely pleasurable. In fact, that’s the definition of obsession. It’s an unwanted, intru
sive thought.”
“I didn’t know that.”
Eric wrote, obsession with Renée. “What are your thoughts about?”
“It’s like I get this weird thought that I’m going to hurt her, not that I would mean to hurt her, that somehow I would hurt her accidentally. I would never hurt her, not on purpose, ever.” Max hesitated, then raked his hair again. “I mean, she’s amazing, she’s great. She’s so nice and sweet. I would never want anything bad to happen to her.”
Eric took notes. “That’s common with OCD, the fear that you might harm someone else without meaning to.”
“Really?” Max’s eyes rounded slightly. “I can’t believe that.”
“It is very common.”
“I thought it was only me. It makes me feel like a terrible person.”
“Consider this for a moment, Max. You don’t have control over your thoughts, not really. They come to you. You don’t have any agency in them, do you understand what I mean? You don’t cause them. You can’t will them to come or wish them away. They’re just there, like clouds.”
“Okay.”
“Actions are completely different. Actions are separate from thoughts. You can have all the thoughts you want all day long, whether they’re scary, or evil, or sexual, or whatever. You don’t have to act on your thoughts. Most people never act on their thoughts, one way or the other, but don’t blame yourself for having your thoughts. You’re no more to blame for having your thoughts than you are to blame for breathing. You’re a human being, so you’re going to think. You with me so far?”
“Yes.” Max smiled slightly, and Eric took that as a plus, trying to create a safe atmosphere in which the boy would open up.
“And, if you blame yourself for the thoughts, you’re sending yourself the wrong message about yourself. You’re alienating yourself from yourself, and that’s not healthy. Just let whatever thoughts you have come, and in time, as we work together, you’ll get to the point where you can say, ‘that’s just a thought I’m having.’ ‘It doesn’t mean I’m a bad person.’ ‘And it doesn’t mean I have to act on that thought.’”
“All right.” Max checked his watch, and Eric knew he was counting down until he tapped his forehead again.