“When I load the dishwasher, I count plates. If there’s an even number above ten in there, all is well. If not, I add the correct number of clean ones to make it right. Same with forks and spoons. There has to be at least twelve pieces in the little plastic caddy at the front of the dishwasher. Which, since I live alone now, usually means adding clean ones.”

What about knives, I ask, and he shakes his head at once.

“Never knives. Not in the dishwasher.”

When I ask why not, he says he doesn’t know. Then, after a pause, he gives me a guilty sideways look. “I always wash the knives by hand, in the sink.”

Knives in the silverware caddy would disturb the order of the world, I suggest.

“No!” he exclaims. “You understand, Dr. Bonsaint, but you don’t understand completely.”

Then you have to help me, I say.

“The order of the world is already disturbed. I disturbed it last summer, when I went to Ackerman’s Field. Only I didn’t understand. Not then.”

But you do now? I ask.

“Yes. Not everything, but enough.”

I ask him if he is trying to fix things or only trying to keep the situation from getting worse.

A look of unutterable relief fills his face, relaxing all the muscles there. Something that has been crying out for articulation has finally been spoken aloud. These are the moments I live for. It’s not a cure, far from it, but for the time being N. has gotten some relief. I doubt if he expected it. Most patients do not.

“I can’t fix it,” he whispers. “But I can keep things from getting worse. Yes. I have been.”

Again I have come to one of those branching points. I could ask him what happened last summer-last August, I presume-in Ackerman’s Field, but it is probably still too early. Better to loosen the roots of this infected tooth a little more first. And I really doubt that the source of the infection can be so recent. More likely, whatever happened to him last summer was only a kind of firing pin.

I ask him to tell me about his other symptoms.

He laughs. “That would take all day, and we only have…” He glances at his wrist. “…twenty-two minutes left. Twenty-two is a good number, by the way.”

Because it’s even? I ask.

His nod suggests I am wasting time with the obvious.

“My…my symptoms, as you call them…come in clusters.” Now he’s looking up at the ceiling. “There are three of these clusters. They poke out of me…the sane part of me…like rocks…rocks, you know…oh God, dear God…like the fucking rocks in that fucking field…”

Tears are coursing down his cheeks. At first he doesn’t seem to notice, only lies on the couch with his fingers laced together, looking up at the ceiling. But then he reaches for the table beside him, where sits what Sandy, my receptionist, calls The Eternal Box of Kleenex. He takes two, wipes his cheeks, then crumples the tissue. It disappears into the lace of his fingers.

“There are three clusters,” he resumes, speaking in a voice that isn’t quite steady. “Counting is the first. It’s important, but not so important as touching. There are certain things I need to touch. Stove-burners, for instance. Before leaving the house in the morning or going to bed at night. I might be able to see they’re off-all the dials pointing straight up, all the burners dark-but I still have to touch them to be absolutely sure. And the front of the oven door, of course. Then I started touching the light switches before leaving the house or the office. Just a quick double-tap. Before I get into my car, I have to tap four times on the roof. And six times when I get to where I’m going. Four’s a good number, and six is an okay number, but ten…ten is like…” I can see one tear-track he’s missed, running a zigzag course from the corner of his right eye to the lobe of his ear.

Like going steady with the girl of your dreams? I suggest.

He smiles. He has a lovely, weary smile-a smile that’s finding it increasingly hard to get up in the morning.

“That’s right,” he says. “And she’s got her sneaker laces tied at the bottom so everyone knows it.”

You touch other things? I ask, knowing the answer to this. I have seen many cases like N. during the five years I’ve been in practice. I sometimes picture these unfortunates as men and women being pecked to death by predatory birds. The birds are invisible-at least until a psychiatrist who is good, or lucky, or both, sprays them with his version of Luminol and shines the right light on them-but they are nevertheless very real. The wonder is that so many OCDs manage to live productive lives, just the same. They work, they eat (often not enough or too much, it’s true), they go to movies, they make love to their girlfriends and boyfriends, their wives and husbands…and all the time those birds are there, clinging to them and pecking away little bits of flesh.

“I touch many things,” he says, and again favors the ceiling with his weary, charming smile. “You name it, I touch it.”

So counting is important, I say, but touching is more important. What is above touching?

“Placing,” he says, and suddenly begins to shiver all over, like a dog that’s been left out in a cold rain. “Oh God.”

He suddenly sits up and swings his legs over the edge of the couch. On the table beside him there is a vase of flowers in addition to The Eternal Box of Kleenex. Moving very quickly, he shifts the box and the vase so they are diagonal to each other. Then he takes two of the tulips from the vase and lays them stem to stem so that one blossom touches the Kleenex box and the other the vase.

“That makes it safe,” he says. He hesitates, then nods as if he’s confirmed in his mind that what he’s thinking is the right thing. “It preserves the world.” He hesitates again. “For now.”

I glance down at my watch. Time is up, and we’ve done quite enough for one day.

“Next week,” I say. “Same bat-time, same bat-station.” Sometimes I turn this little joke into a question, but not with N. He needs to come back, and knows it.

“No magical cure, huh?” he asks. This time the smile is almost too sad to look at.

I tell him that he may feel better. (This sort of positive suggestion never hurts, as all psychiatrists know.) Then I tell him to throw away his Ambien and “the green moth pills”-Lunesta, I assume. If they don’t work at night, all they can do is cause trouble for him during his waking hours. Falling asleep on the 295 Connector won’t solve any of his problems.

“No,” he says. “I suppose not. Doc, we never discussed the root cause. I know what it is-”

Next week we may get to that, I tell him. In the meantime, I want him to keep a chart divided into three sections: counting, touching, and placing. Will he do that?

“Yes,” he says.

I ask him, almost casually, if he feels suicidal.

“The thought has crossed my mind, but I have a great deal to do.”

This is an interesting and rather troubling response.

I give him my card and tell him to call-day or night-if the idea of suicide begins to seem more attractive. He says he will. But then, almost all of them promise.

“In the meantime,” I say at the door, putting my hand on his shoulder, “keep going steady with life.”

He looks at me, pale and not smiling now, a man being pecked to pieces by invisible birds. “Have you ever read ‘The Great God Pan,’ by Arthur Machen?”

I shake my head.

“It’s the most terrifying story ever written,” he says. “In it, one of the characters says ‘lust always prevails.’ But lust isn’t what he means. What he means is compulsion.”

Paxil? Perhaps Prozac. But neither until I get a better fix on this interesting patient.

June 7, 2007

June 14, 2007

June 28, 2007

N. brings his “homework” to our next session, as I fully expected he would. There are many things in this world you can’t depend on, and many people you can’t trust, but OCDs, unless they are dying, almost always complete their tasks.