The e-mail arrived on March 16, 2024, at 5:54 P.M. As any parent with young kids knows, this is one of the worst stretches of the day to lose focus—not to mention to have your whole life turned upside down. So it was that I scolded myself for even checking my inbox, and then, while attempting to manage dinnertime for our twin infants and two-year-old, tapped the message.

As I skimmed it, the air became cold on my skin, alerting me to the sweat materializing on my forehead and neck. On the second, more attentive read, my toes and fingers started to clench. On the third go-round, tunnel vision began setting in, which had the perverse effect of making it even easier to give this monstrous thing my attention. And I did, reviewing it again and again, all while my family ate dinner beside me, oblivious to the tempest tearing through my mind.

Soon enough, having read it so many times that I couldn’t, well, actually read, I went to the other room and began speaking it aloud. I even tried on varying emphases, unusual cadences, dramatic intonations, so desperate was I to extract every last morsel of meaning hidden inside. And, when I’d finally exhausted all the ways to speak the words, I sang them, first with serious songs, and then, tapping into yet another part of my brain, with silly melodies—the “Nutcracker” theme, the Monday Night Football anthem. Doing this made me feel a bit insane, but I didn’t care, and why would I? There was nothing—nothing—in the world more important than this e-mail.

And what was it, you ask? A biopsy result? A legal summons? An anonymous threat? Would you believe me if I said that it didn’t, in fact, matter? During this period of my life, one that was entirely consumed by obsessive-compulsive disorder, virtually every e-mail that landed in my inbox had the same effect on me. Case in point: this particular missive was one of the least important e-mails one could possibly receive—a spammy weekly newsletter from our state’s junior senator. (“Welcome to Kirsten’s New York Minute!” it started. “Here’s what she’s been up to this week.”) Now, consider that on any given day I received somewhere between ten and forty e-mails. And this isn’t to mention messages and notifications on social media, and actual parcels of mail. Nor does it account for things I wrote myself—the hardest challenge of all. In fact, I found this last category, which at the time included edits to my third novel and a long-form magazine article, so difficult that I occasionally lost entire days to a single sentence.

I wasn’t always like this. Actually, for most of my adult life, I didn’t even think of myself as someone with O.C.D. But, in the course of a few years, the disease had risen, slowly but surely—before exploding, right after the birth of our twins, with a force I never could have imagined. The suddenness of it all was terrifying, even paralyzing, and yet, at the same time, oddly relieving. After all, I’d reasoned at the start, if such a thing could come out of nowhere, wouldn’t it go away just the same? No, it wouldn’t—that quickly became apparent. As did the fact that, unless I got help, I might lose the ability to function in everyday life. How could I return from my parental leave in this state and keep my job? How could I write books? How could I possibly be a parent and husband?

When I first saw Alex’s picture online, something clicked deep inside me. (Alex is not his real name.) He looked intelligent, gentle, well moisturized. He looked like he could have been a screenwriter, if only he hadn’t had such a good childhood. Browsing his profile on Psychology Today, I quickly found other pluses: he appeared professionally accomplished, older than me but not old, and very low on the woo-woo scale. (His training was in exposure and response prevention, a mainstream form of cognitive behavioral therapy.) Of course, there were minuses, too: he was based in midtown Manhattan and didn’t take my insurance. But these were hardly disqualifying—and, anyway, what did it hurt to try?

“Andrew?” he asked, entering the waiting room. That he looked exactly like his picture—the same stubble, the same smile—was, for some reason, soothing. I followed him into his office, which was well appointed yet not overly self-aware—no wall of books, no statement furniture. Also unlike the stereotype, his chair wasn’t angled away from mine, as if we each needed to look into the middle distance, but directly facing me, and only a few feet away.

He started with the obvious questions: “What’s most difficult for you right now?” “When did things get worse?” Then, as soon as we’d finished outlining my experience, he said, a kind smile lighting his face, “You know what? I think we can definitely help you.” I was a bit turned off by the falseness of the “we”—as if, after every session, he’d huddle with a supergroup of therapists to dissect my progress and needs. It was a small quibble, though it wasn’t a one-off; it turned out, in fact, to be the beginning of a theme.

Perhaps sensing my dissatisfaction, he soon pivoted, asking if we could dig into my compulsions—specifically, my nightly stove-checking ritual. When I noted that this paled in comparison with things like e-mail, he replied, with disarming authority, “Andrew, it’s all related.” Then, his tone already warm again, he continued, “I’m curious: If you didn’t check the stove, what’s the worst that could happen?”

This was easy to answer, given that such a scenario played in my head every time I walked into the kitchen. I said that the stove could, actually, be on. This worry wasn’t even that irrational; my wife, Mette, had forgotten to turn it off at least ten times in the five years we’d lived together.

“And then what would happen?” he asked.

“Well, then gas would leak out of the stove, which is near where the twins sleep.”

“And then?”

“The twins would breathe in the gas while they slept, which could kill them. And, of course, there could also be a fire.”

“What would be so bad about a fire?”

“What would be so bad about a fire,” I repeated. “Well, not only could my family die but the other families in our building could, too.”

With measured silence, he let me soak in this image, which I now saw from the vantage point of firefighters outside our building, their colleagues excavating our corpses while our neighbors watched in disbelief. The thought was dark, devastating, sinister even, though when he asked how I felt, the one word that came to mind was, surprisingly, “relieved.” We were dead, yes, our family was gone—but now there was nothing more to worry about.

Abruptly moving on, like a magician preventing his audience from lingering on his last trick, Alex pulled out a tablet, holding it up to me. Displayed was a simple, almost childlike squiggle: a jagged line jolting up and down. “This is how we experience O.C.D.,” he said, “as measured by anxiety over time.” The implication was that I was witnessing my own emotional journey. My actual experience of O.C.D. felt far too messy to be captured by a two-dimensional chart, let alone a single line—and yet, the more I looked at it, the more I recognized its peaks and valleys, which sometimes convulsed higher or lower than usual, but in no discernible pattern or trend.

What if, I began to wonder, I tried framing my O.C.D. in this way? What if I reduced my entire experience of it to the anxiety it gave me, and then allowed that anxiety only a single value at any given time? This didn’t just force me to think differently about my O.C.D.—it completely violated my conception of it. After all, anxiety is such a physical thing, a mere component of the O.C.D. machine; it was as though I were being asked to contemplate a vehicle only by measuring the fuel it consumed. To do so, I would have to forget everything else, all of what I actually obsessed about: the health of my children and my writing and my family’s finances and my e-mails. In other words, I would have to leave behind meaning itself.

“So, it’s time for your first exposure.” Alex’s smile was, somehow, just as radiant through the screen of my laptop. (We’d switched to remote, saving me a brutal commute.) The statement prompted a mix of excitement and dread. As Alex had since explained, each exposure he assigned would be designed to trigger one of my obsessions. The theory was that by provoking my anxiety, while denying myself my normal coping strategy (compulsions), I would, over time, become numb to it, breaking the cycle.

“One of the first obsessions we discussed had to do with your oven—correct?”

Relief shot through my veins. Yes, that was the first obsession we discussed, though he had to know by this point that my true nemesis was reading and writing—didn’t he?

“That’s right.”

“Great. So, what you’re going to do is intentionally make contact with the oven knobs, and then resist checking to make sure the stove is off.”

I immediately laughed. “For me to not check the knobs of the oven, I mean . . . isn’t that kind of . . . just what I’d do if I were, you know, normal?”

He gave his usual smile: patient yet confident. “Yes. In fact, a lot of exposure therapy is about mimicking what we would do if we were, as you say, normal. But you know better than anyone that this won’t be a normal experience for you. It’s going to involve a lot of anxiety. The trick is that, once you trigger that anxiety, you refuse to resort to your compulsions. Instead, you give the anxiety all of your attention.”

There was something subtly sublime about the way he used that word, “anxiety.” It was as if he’d transformed it from a purely abstract concept—one as nebulous as bad weather, or ominous music—into an object like any other.

When the session ended, and Alex’s face vanished from my screen, I found that I didn’t want to wait a second more. Without thinking, I lifted myself from the chair, strode across the room, and opened the door. There, not four feet away, I saw the familiar stainless-steel knobs, five in all. I could almost feel my thumb and pointer on the first, my normal starting point. So, too, could I conjure, through muscle memory alone, the soft yet firm resistance that came with the smallest turn right, then left, then right, then left, each minute rotation concluding with a light, muted, satisfying click.

Standing in the doorway, stopping myself from getting any closer, I took in the entire apparatus: the curve of the oven’s long metal handle, the coarse black grills, the army of buttons surrounding the clock. Like most modern appliances, the more you inspected it, the less cohesive it appeared, the more contrived, the whole gestalt collapsing with every passing second. Who put it here, this oven? And when, exactly? It began to seem antagonistic, an intruder—and yet, oddly enough, its presence excited me, too.

I ambled over and, before I could outthink myself, brushed my hip against a few of the knobs. That I didn’t know exactly how many I’d touched—two? four?—was already enough to unleash a torrent of anxiety. This I had more or less expected. What I hadn’t prepared for—what I couldn’t have—was how the anxiety evolved as I continued standing there, watching the oven, trying with all my might to keep myself still. It wasn’t the emotion’s intensity that surprised me. It wasn’t even my all-consuming focus on what I was feeling. It was what the anxiety did—or rather, what it didn’t do. It wasn’t fuelling my compulsions. It wasn’t bending my thoughts. It wasn’t doing anything at all. It was like a verb without a subject. It was energy free from matter. Yes, it was a fire that burned nothing but itself, a flame floating in the sky.

About two months after I started exposure therapy, my parental leave ended, and I returned to my job. (At the time, I designed products at a financial-technology company.) I was sad to move on from that brief epoch of my life, and also a little worried. I was right to be. If, at first, it seemed as if not much in the office had changed—besides the fact that they’d taken away the free gum—once I finally cracked open my laptop, it felt like the entire world had.

For starters, I was no longer used to the sheer amount of information I was expected to read and respond to every minute. I’d even lost the muscle memory required to seamlessly traverse the universe contained in my sixteen-inch screen. During meetings, I’d watch dumbstruck as co-workers handled their devices as if they were an extension of themselves, an extra limb, something they weren’t merely interacting with but funnelling their reflexes through.

But it wasn’t just that I was rusty, obviously. I’d simply never had to function in a workplace while struggling with severe O.C.D. In fact—and I’m embarrassed to admit this—it was the first time I fully appreciated that the disorder could actually prevent someone from having a job. (According to the International O.C.D. Foundation, as many as two out of five O.C.D. sufferers are unable to work because of psychiatric symptoms.) Every time I went to the bathroom or got a coffee, I’d return to find five, ten, twenty messages waiting for me. If I’d allowed myself to obsess over these as much as I did e-mails and texts, it would have taken me weeks just to get through a single workday.

Given how overwhelming these messages were, I knew that, as had been the case with my personal e-mail, direct exposures would be too difficult for me. Instead, I’d need to ramp up my tolerance for distress across the board, letting the rising tide lift all boats. (After all, as Alex would say, “it’s all related.”) So I made a note to talk this over with him, hoping he’d craft something especially demented. But, mere minutes before we were next to meet, something on my kitchen counter caught my eye. And from this everyday sight emerged an idea.

When I told Alex that not only did I need to drastically increase the difficulty of our exercises but I had the perfect exposure to get us there, he looked like a father learning that his son had been selected by NASA to go into space. He even held up his hand for a virtual high five, the gesture just a bit too embarrassing to reciprocate. I was proud, though, even if I couldn’t own up to it—so much so that I almost forgot what I’d signed myself up for.

One way in which my O.C.D. manifested was that it was very, very hard for me to let a mess of any sort go uncleaned, whether it be splattered milk, scattered crumbs, or even just a splash of water. My response was so automatic—a satisfying swipe of paper towel—that my anxiety hardly had time to express itself. But it wouldn’t be enough to merely stop myself the next time I came across such a scene. No, in order to generate the greatest measure of agony, I’d not only have to produce a mess myself, but do so with the greasiest, most viscous, unwipeable material on hand: extra-virgin olive oil.

Right after our session ended, just as I’d done for my first exposure, I walked straight into the kitchen. But unlike that initiation into the rites of self-administered pain, I now had to actually put something out into the world. I had to give my anxiety dimension and form, shape and color. I had to, in a way, give it life. This, I was coming to understand, was what was so miraculously sublime about exposures: they were a way to be reckless, even self-destructive, but without any lasting repercussions.

I picked the bottle of olive oil off the counter, noting the give of the plastic: the twist nozzle was, it seemed, already open. Turning it horizontal, then tilting just a bit more, as if I were dipping a dance partner, I began to feel hot angst pulsing through my arms and legs, lessening the weight of my body, lessening the weight of the world. Then, tightening my grasp, I watched as a trickle of fluid fell from the spout. If it was, I realized, more than I’d planned to release, it was also, in this way, the perfect amount.

Putting the bottle back, I stepped aside and cocked my head, a painter judging his work. It was then that the first itch came to me, and with it the onrush, the anxiety, the anguish, the distress and the pain and the tightness. That there were so many equally viable terms for this thing in me suddenly seemed like proof that none of them was correct, or that all of them were; it was, in other words, up to me how to interpret the feeling. But if that were true, well, how far did my command of it go? Had I even, in some way, imagined this fluttering restlessness into being? Was its bright, lemony sting actually of my own design? Perhaps it was more like the surprises that await us in our dreams—an experience conjured by the mind solely for it to surrender to. That was, it seemed, the point of this all: to surrender, to be ravished, overpowered, electrified, the meat of my body turned into a mere conduit for this oozing, tingling release. Yes, if I had, up until now, considered myself the subject of this experience, I now realized I was its object. It wasn’t that something was blooming in me but that it was blooming me, the anxiety like the spring and my body a tree. How could it be, I wondered, that we did all we could, day in and day out, to avoid this feeling, when it was, in all of its terribleness, all we’d ever wanted: submission, a taste of death, a reminder that we were, in the end, at the whim of nature, a figment of it? Wasn’t this, after all, what it meant to be alive?

In mid-September, I began writing about my experience, originally in the form of a book. It had hardly been a week since I’d finished up the copy edits on my third novel, but still I was eager to start something new.

And yet, writing felt different now, and in quite a few ways. For starters, I could no longer do it at my usual pace—thanks to the fact I now had three kids, a job to commute to, and, of course, the time suck of compulsions. (Despite all my progress, these still stole about ninety minutes each day.) But there was something else, something even more fundamental, that made writing this first draft far more difficult than ever before: I just couldn’t approach it like one.

Every day, once I hit my five-hundred-word quota, I’d start editing in the way many writers do—restructuring the passage, refining its arc, transposing sentences and ideas. Then I’d take care of localized problems, such as clunky transitions and convoluted phrasing. By this point, I’d be ready to call it a day—and yet, I’d sense I should go through it just once more. As expected, I’d find a word that wasn’t quite right, or a sentence begging to be deleted—all the evidence I needed to have another go. That time, too, I’d spot an upgrade, and so, naturally, I’d do it again, and again, and again, until there was, at last, nothing to be changed. I’d managed to produce an airtight passage, one devoid of a single blemish—but now this was, suddenly, no longer enough. After all, good writing isn’t just an absence of flaws; well-crafted prose flows, it feels natural, it’s convincing and clear. In short, it just works. So I’d start working through the passage all over again—though this time, I wouldn’t read so much as I’d review, zooming out enough to distill what I’d written into a string of neat, abstract concepts. Using this paragraph as an example, that would be: [Start editing normally] —> [O.C.D. makes me eliminate every flaw] —> [No flaws left, but need to feel writing flows] —> [Abstract the writing into simple ideas]. Again and again, I’d slide my eyes over the passage, getting a feel for its constituent concepts until I could quite literally feel them: after ten or fifteen reads, I’d begin assigning each concept a certain motion of my hands, the gestures demonstrative yet simple. Here those would be: [hand slides back-and-forth, palm-down, as if petting a cat] —> [hand lifts up, fingers wiggle] —> [hand plateaus, palm turns up] —> [hand draws a circle in the air]. By performing this sequence with fluidity and grace, I could eventually (after an hour or two) convince myself that the writing it represented was equally harmonious—and thus I could finally call it a day.

As I debriefed Alex on all of this, he produced vigorous, sympathetic nods. But, as we started working through it, I began to sense that, for all his care and attention, he wasn’t actually helping me find a solution. This feeling was later reinforced when I read the corresponding homework assignment: “Limit mental reviewing and repeating/reading of new writing.” I mean, yes, of course I should! Was this really what he was getting three hundred and fifty dollars a session for?

I wasn’t being fair. I at least knew that. Yes, I was making excuses. I was even, to use that dreaded Freudian refrain, projecting. If I was begrudging Alex for his ineffectiveness, his inability to take action, it was only because I myself was guilty of these crimes. I already knew, deep down, exactly what I had to do.

The next day, as soon as I set to work, I became keenly aware that what I was writing would, soon enough, be abandoned, left to rot, banished to a state of suspended inadequacy. If this was a severely uncomfortable feeling, it also contained a trace of joy. Merely by shifting the emphasis away from the result, I found that I paid more attention to the actual act of creation—and thus reclaimed some of the thrilling freedom of a true first draft.

As expected, the first reread required heavy lifting. The second, too, wasn’t as clean as I’d hoped. On the third read, I found that the passage was finally coming together. Then, as I began my fourth pass—what I’d decided beforehand would be the end of my editing and the start of my exposure—I started to feel it, the changing of the tide, the spoiling of logic, the irrevocable metamorphosis whereby my love of writing and editing and expressing myself became a fear of imperfection, of failure.

The second I finished reading I closed my laptop. Desperate to do anything but sit there, I went to brush my teeth. This was a terrible idea. Mindless, physical tasks—taking a shower, doing the dishes—created the perfect conditions for my O.C.D. to thrive. And sure enough, as I robotically dragged the brush through my mouth, I was quickly sucked into a whirlpool of obsession. Oh, how nice it would be, I thought, to read the passage just a few more times, and then maybe a few more times after that—until, by some miracle of intuition, it suddenly all felt right.

Reflecting on this state of near bliss, and how impossibly far away it seemed, I had a sort of epiphany. Perhaps it was merely the intensity of my distress, which often helps rewire my brain. Or maybe it was that I was just thinking about my book, which tends to bring out the most driven, determined sides of myself. Either way, it suddenly occurred to me that the decision before me was not really about whether or not I would fail. Or at least it didn’t have to be. Yes, I could just as easily consider this a chance to succeed, couldn’t I? One big test of will. An opportunity to showcase my ambition—if not weaponize it.

It worked. Reframing the choice in this way allowed me to see my anxiety not just as something to be experienced but as something to be accomplished, much like the word quota I held myself to each day. This not only helped me resist going back to my laptop that night, but enabled me to recast the still-simmering anxiety I brought with me into sleep as a good thing—a testament to my resolve, even.

I was a bit surprised, however, to find that when I awoke it was still there. In fact, as I began to work, and made my way through my allotted four rereads, I already felt more anxious than I had at my peak the day before. And yet, as excruciating as this was, it didn’t make me question what I was doing. After all, it fit perfectly within the paradigm I’d set for myself: if I was approaching anxiety as something to master—a sort of mental training, even—it was only natural that it should become incrementally more challenging. And it did, day after day after day. By the time I went to sleep on October 30th, one week after I’d started the exposure, my steady state had become one of near panic—and I wouldn’t have changed a thing. Not only was I overcoming my O.C.D., but, it must be said, I was making great progress on the book itself.

At around 4 A.M., I awoke with an intense and unusual pressure in my abdomen. Staring up at the ceiling, massaging my gut, I recalled that just before I woke, I’d dreamt that I was forcing myself to shit. Was it possible that I’d strained so hard in my dream life I’d injured my actual body? I put this somewhat pathetic thought away and rolled over. But then I suddenly felt hot, and my vision became grainy, and I realized I was losing consciousness.

The next thing I knew, I was sweating, unable to speak, trying to decipher Mette’s voice, which was tinny and distant. Was I having a heart attack? A stroke? Perhaps it was just my confused state, but I was surprisingly O.K. with the prospect that this was it, that I was dying. After all, I mused, I’d already achieved a full life: three children, three books, a loving wife. After Mette called 911, I told her I loved her with all of my heart, and began to cry.

It’s a savage fact of life that when someone thinks that they’re dying they end up in an emergency room. Is there any worse place to shuffle off your mortal coil? The bright lights, the incessant beeping, the persistent marginalization. In the treatment bay, I found myself parked directly in front of a man fresh from a fistfight—and, judging by his stare, he was eager for another. I considered asking for a bed, though I knew this wasn’t feasible. There were plenty of people waiting, and, looking around the room, I realized that they were all far worse off. This had the unanticipated effect of making me feel, of all things, quite lucky; I was, it had started to become clear, not dying at all.

This was confirmed by the doctor, who spoke to me with a mix of condescension and curiosity. Why, she seemed to be thinking, did he come all this way? Realizing that, in her world, fainting was nothing to write home about, I doubled down on the stomach pain. I even told her about the dream. Wasn’t it possible, I asked, that I’d strained so hard I’d damaged my intestines? No, she said. That’s not possible. Then, before I could badger her with more hypotheses, she said that my stomach pain was most likely, humiliatingly, gas. So it was: they were letting me go, my discharge papers bearing just one diagnosis: “Gas, Excess.”

As soon as I got out, I called my mom and, hoping to dampen her distress, assured her everything was fine. It was in this vein that I reflexively dismissed her observation that I’d been visibly stressed recently, “with your writing and everything else.” But, after we hung up, the thought lingered. This was, amazingly, the first time I considered that this all might have been caused by the very thing I’d spent the entire year thinking about: anxiety.

When I arrived home, sleep-deprived, the prospect of death still fresh in my mind, I couldn’t help but sense that the world was, in a way, different. It was a subtle, indescribable shift; everything seemed off-kilter, but at the same time, it all felt so harmonious, too. Walking around the apartment, it struck me that certain random objects now appeared simpler somehow, as if they’d been stripped of all of the fuzzy associations that accumulate over time. Our coffee grinder was just a coffee grinder. The shower curtain was merely a shower curtain. Adding to the uncanniness of it all, it was Halloween. After work, we strolled the streets collecting candy, then stopped at our favorite Italian restaurant for dinner. Sitting out front, watching families in bizarre costumes stream by, the thought crossed my mind not just a few times that I had, actually, died. And, in a way, I had. Yes, after almost a year of resisting, I had finally yielded to the fire in my mind, allowing it to consume the rest of me. But of course, at a certain point, there was simply nothing left to burn. ♦