What Happens When You Try to Treat OCD With Psilocybin

Adam Strauss is standing in his New York apartment, holding the limp cord of his headphones, trying to decide between the two MP3 players on his desk: the iPod and the iRiver, its Korean counterpart. He listens to the same song on each one, flipping the silver plug of his headphones back and forth like a 1930s switchboard operator.

He tries different songs, different genres, different instruments. The iRiver tends to sound better overall, but the iPod offers a bit more nuance in the midrange. The iPod has better battery life, but the iRiver still lasts eight hours, longer than he’s ever listened to music continuously. Then again, he never owned an MP3 player. Is eight hours enough?

He goes back and forth, back and forth, testing vocal ranges, button resistance, interface aesthetics. His internal monologue scrolls like a ticker tape. Does aesthetics really matter? It will stay in my pocket most of the day. I’ve never seen a line out the door at the iRiver, but people line up at the Apple Store to get the iPod. Maybe these people know something I don’t. Or maybe these people are all idiots, paying extra for an inferior device!

It would be one thing if it was only Adam’s decision as to which MP3 player to buy. After all, it was 2003, the height of the personal audio device revolution, and Adam was a 29-year-old audiophile. But it wasn’t just the iPod versus the iRiver. For Adam, it was about other decisions as well: what shirt to wear to work, what to order for lunch, and even which side of the street to get off on.

At one point, in an effort to simplify his clothing decision-making process, Adam purchased 11 identical blue button-down shirts. But he quickly discovered variations in the fit and fading of each shirt. He believed there was a RIGHT shirt to choose; every morning he spent 20, 30, then 45 minutes trying to find it. If he could only figure out which shirt was better, he could control his destiny.

Somehow, Adam knew how ridiculous this had all become. He wasn’t stupid; he had graduated from an Ivy League university and ran his own company, which, at the time, was the world’s largest digital library of downloadable sound effects. He was educated, talented and successful, but lately his obsessive-compulsive disorder has taken over his life.

OCD results from a complex mix of brain chemistry, genetic predisposition, and environmental factors. However, in one conversation, Adam compares his OCD to a drug addiction. “Heroin is not what addicts are looking for; they’re looking for the high. Heroin is what gives them the high,” he told me. “With OCD, certainty is the heroin, and the high is the brief hit of dopamine you feel when you feel like you’ve found it.”

But with OCD, he didn’t need to hit the streets to get his fix. The only tools he needed lived in his head. Adam would make up his mind…it must be the iRiver– then convinced himself that he hadn’t listened to enough hip-hop. Before he knew it, both boxes were open on his desk and he was moving the headphone cord over and over again.

Soon, Adam was canceling plans with friends, arriving late for work, and spending sunny Saturdays cooped up in his Manhattan apartment. In an effort to hide his OCD from others, he closed himself off from social situations, which, in turn, left him more time to spend locked in thought.

“For drug addicts, heroin is a great simplifier,” he told me. “All you care about is getting your next fix. Everything else pales in comparison.” For Adam, it was the same when it came to decision-making. The rest of his life could only begin after he knew what the best MP3 player was. He was stuck in a vicious cycle and desperately needed a way out.

The desire for control shapes our decisions, our relationships, and our perceptions of our environment. Psychologists consider the desire for control to be a basic psychological need. Yes, having control over your life is generally a good thing. But when the desire for control becomes all-consuming, or when we attempt to control what we fundamentally cannot control, it can be devastating.