What Happens When You Try to Treat OCD With Psilocybin

Adam Strauss is standing in his New York City apartment, holding the limp cord of his headphones, trying to choose between the two MP3 players on his desk: the iPod and the iRiver, its Korean counterpart. He cues up the same song on each, toggling 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 little more nuance in the midrange. The iPod has a better battery life, but the iRiver still lasts eight hours—­longer than he’s ever continuously listened to music. Then again, he’s 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 monolog races like ticker tape. Do aesthetics even matter? It’s going to be in my pocket most of the day. I’ve never seen a line out the door for the iRiver, but people line up at the Apple Store to get the iPod. Maybe those people know something I don’t. Or maybe those people are all chumps, paying a premium for an inferior device!

It would be one thing if it were just Adam’s decision of 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 also other decisions—­what shirt to wear to work, what to order for lunch, even what side of the street to walk down.

At one point, in an effort to simplify his decisionmaking process for what to wear, Adam bought 11 identical blue button-­down shirts. But he quickly found variations in each shirt’s fit and fading. He believed there was a right shirt to pick; each morning he would spend 20, 30, then 45 minutes trying to find it. If he could only determine which shirt was best, he could control his fate.

On one level, Adam knew how ridiculous it all had become. He was no fool; he’d 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 was taking over his life.

OCD arises from a complex mix of brain chemistry, genetic predisposition, and environmental factors. In conversation, though, Adam compares his OCD to a drug addiction. “Heroin isn’t what the opiate addict is looking for; they’re looking for the high. The heroin is just the thing that gives them the high,” he told me. “With OCD, certainty is the heroin, and the high is the brief dopamine hit you get when you feel like you’ve found it.”

But with OCD, he didn’t need to go out to the street to get his fix. The only tools he needed lived in his head. Adam would make up his mind—­it’s got to be the iRiver—­and then convince himself that he hadn’t listened to enough hip-­hop. Before he knew it, the two boxes were open on his desk and he was moving the headphone cord back and forth again.

Soon Adam was canceling plans with friends, showing up late for work, and passing sunny Saturdays locked inside of his Manhattan apartment. In an effort to conceal his OCD from others, he closed himself off from social situations, which, in turn, left him with more time to spend trapped in his thoughts.

“For junkies, 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 with decision­making. The rest of life could begin only after he knew which was the better MP3 player. He was stuck in a vicious cycle and in desperate need of a way out.

The desire for control shapes our decisions, relationships, and perceptions about our environment. Psychologists consider the desire for control to be a fundamental psychological need. Yes, being in control of 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, ­it can be devastating.