This morning’s *New York Times* includes an article: “When Anxiety Is at
the Table” by Jeff Bell. 2/6/2008

Here’s the article:

FOR some of us the trouble starts before we even step into a restaurant.

If Carole Johnson, a retired school administrator who lives near
Sacramento, Calif., happens to have a distressing thought while passing
through a doorway, she needs to “clear” the thought by passing through
the door twice more, doing it precisely three times.

My own challenge is fighting the urge to return to my parked car and
check yet again that the parking brake is secure. If I don’t, how can I
be sure my car won’t roll into something — or worse, someone?

Ms. Johnson and I are but two of the estimated five to seven million
Americans battling obsessive-compulsive disorder, an anxiety disorder
characterized by intrusive distressing thoughts and repetitive rituals
aimed at dislodging those thoughts. We are an eclectic bunch spanning
every imaginable cross-section of society, and we battle an equally
eclectic mix of obsessions and compulsions. Some of us obsess about
contamination, others about hurting people, and still others about
symmetry. Almost all of us can find something to obsess about at a restaurant.

Sometimes the trouble is the element of public theater in the dining
room, meaning we have to indulge in our often-embarrassing rituals under
the eyes of so many strangers while trying not to get caught. Or it
might be worrying about the safety of the food and the people who serve it.

Many of the situations that unsettle people with obsessive-compulsive
disorder — driving, for instance — provoke at least some level of
anxiety in just about everyone. But restaurants are designed to be
calming and relaxing. That is one of the main reasons people like to eat out.

To many of us with obsessive-compulsive disorder, those pleasures are
invisible. We walk into a calm and civilized dining room and see things
we won’t be able to control. This feeds directly into one of the
unifying themes of the disorder: an often crushing inability to handle
the unknown.

“The common thread, I think, has something to do with certainty,” said
Dr. Michael Jenike, medical director of the Obsessive Compulsive
Disorders Institute at McLean Hospital in Belmont, Mass., which is
affiliated with Harvard Medical School. “If you have O.C.D., whatever
form, there seems to be some problem with being certain about things —
whether they’re safe or whether they’ve been done right.”

If lack of certainty is our common challenge, than warding off
uncertainty is our common quest. For some of us battling obsessive-
compulsive disorder, that means scrubbing our hands to make sure they’re
clean, or checking and re-checking everything around us in the name of
safety. For others, the need is to arrange various items in order, or
repeat actions in ritualized sequences in vain attempts at removing doubt.

These quirks lead to some serious complications in our lives, especially
when we find ourselves in a place that triggers obsessive-compulsive
behavior, like a restaurant. Once Ms. Johnson gets past the door, she
often needs to try out a few tables, looking for one that feels right,
as a frustrated maitre d’hotel looks on.

Personally, I am fine with just about any table, although the wobbly
ones can spell big trouble. I have harm obsessions, which means I am
plagued by the fear that other people will be hurt by something I do, or
don’t do. Seated at a less-than-sturdy table, I conjure images of fellow
diners being crushed or otherwise injured should I fail to notify the
restaurant’s management. This is called a reporting compulsion in the
vernacular of the disorder, and before I learned to fight these urges,
many a manager heard from me.

One of them was the woman running a coffee house I frequent. One day
while sipping my latte at a fake-marble table I leaned forward, and the
far end of the tabletop lifted. This barely moved my coffee cup, but it
sent my nerves right through the roof. Before I realized it I was
crouched over, my head upside down beneath the table. The only
responsible thing to do, I decided, was to ask the woman behind the
counter to come over for a look. Her lack of concern only exacerbated my
problems.

Forget the tabletop, my friend Matt Solomon tells me; it’s what’s on top
of the table, and precisely where, that really matters. Mr. Solomon is a
39-year-old lawyer in Fort Worth with order compulsions. To enjoy a meal
he needs to separate the salt and pepper shakers, and, ideally, place a
napkin holder or other divider midway between them.

Why? He can no more answer that than Ms. Johnson can tell you why she
needs to chew her food in sets of three bites or drink her beverages
three sips at a time. Three is her magic number. That is about as
refined an explanation as any of us can give for our compulsions,
rituals that we understand are entirely illogical.

Some of our other concerns may seem familiar. I imagine most diners, for
example, have noticed and perhaps even struggled to remove white
detergent spots that can sometimes be seen on silverware. But few, I
suspect, have gone to the lengths Jared Kant has to get rid of them. Mr.
Kant is a 24-year-old research assistant living outside of Boston who
has obsessive fears of contamination. (He first came to my attention
when I read a memoir he wrote about living with obsessive-compulsive
disorder.) Last year he visited a Chinese restaurant with several
friends, one of whom pointed out that their silverware was spotted and
seemed dirty. Mr. Kant collected all the utensils at the table and
attempted to sterilize them by holding them above a small flame at the
center of a pu-pu platter, quickly attracting the attention of their waiter.

Ah, waiters, and waitresses. And bartenders. For some with obsessive-
compulsive disorder, the success or failure of a dining experience can
hinge on the appearance of a restaurant’s staff.

Mr. Solomon, for example, feels compelled to inspect the hands of anyone
serving him. Cuts and scrapes are objectionable because in his mind,
they can lead to his contracting a disease that could kill him.

This past Halloween, Mr. Solomon ate at the bar of a steakhouse, where
he was served by a bartender dressed in a devil costume. He noticed a
small red stain on the man’s right knuckle, and couldn’t rule out the
possibility that the stain was blood. Trying to avoid things the
bartender had touched, Mr. Solomon used a straw to drink from his water
glass and swapped the silverware the bartender had placed in front of
him for another set from farther down the bar.

Coincidentally, Mr. Solomon and Mr. Kant have each battled contamination
issues on both sides of the counter. Mr. Solomon spent years working as
a bartender, often consumed by thoughts of becoming deathly ill. He was
convinced that one of his regular customers was carrying a fatal virus,
and came up with strategies to minimize contact. “I would always quickly
put his change down before he could try to take it from my hand,” he said.

The challenge for Mr. Kant was serving lattes. In his late teens, while
training to be a barista, he learned of the potential dangers from
improperly handled milk. He became obsessed with the possibility of
harming customers through inadvertent negligence. Even worse was the
prospect that he might never know. “My biggest fear was that one day I
would find out that a customer had come down sick, brutally sick with
something, and the only thing they knew was that they’d had a latte,”
Mr. Kant said.

I can’t imagine handling even the most basic server duties, like adding
up the items on a customer’s bill. I struggle enough with checking and
rechecking my tip calculations. And that’s just one of my challenges at
the end of a meal.

As part of my harm obsession, one of my concerns is that germs from my
mouth will hurt others. Although I try to keep my fingers away from my
lips and their germs while I’m eating, I’m rarely successful (it’s not
as easy as it sounds). By the end of the meal I believe that my hands
are contaminated. The problem is that I need them to scribble my
signature on the check. If I’m lucky, I will have remembered to bring my
own pen; if not, I may feel compelled to “table-wash” my hands, a little
trick I developed over the years: I use the condensation on the outside
of a cold water glass to rinse off the germs. (Forget drying my hands,
by the way; my napkin would only re-contaminate them.)

Once the check is signed, I must be sure that it is really signed. At my
worst, I have opened and closed the vinyl check holder again and again,
seeing my signature each time, yet unable to feel certain. I’ve left the
table, only to return to check again. And again.

Help is available, in the form of a therapy called exposure response
prevention. As the name suggests, the technique calls for exposing
people with obsessive-compulsive disorder to situations that trigger
obsessions, then preventing them from acting on them. The therapy
addresses low-level anxieties, and works up from there.

With restaurant cleanliness, for example, a therapist might have an
client rate his anxiety about challenges ranging from simply touching
spotted silverware to eating from a spotted plate. Then the therapist
would ask him to face those situations while fighting the compulsion to
clean or replace spotted items.

The therapy attempts to alter behavior, but it appears to alter much
more than that. Dr. Sanjaya Saxena, the director of a program for
obsessive-compulsive disorders at the University of California at San
Diego, said that exposure response prevention therapy “certainly is
changing the brain at the molecular level — that is, at the level of
particular proteins that are expressed and created and on the level of
neurotransmitter function.” In that sense, he said, “behavioral therapy
is biological therapy.”

I am no brain scientist. I understand almost nothing about proteins and
neurotransmitters. But my own extensive work with this particular form
of torture (that is, directed treatment), with medication, has
progressively allowed me to take back much of the life my disorder stole
from me.

Today I travel extensively, sharing my recovery story and working with
groups like the Obsessive Compulsive Foundation to raise awareness. In
my job as a radio news anchor, I don’t have to eat out much, but when
I’m on the road for work related to the disorder, I wind up eating in a
lot of restaurants. I can honestly say I’m starting to enjoy it. In
fact, while I still like ice water with my meal, I often find myself
drinking from the glass, not washing with it.

Now when I say check, please, I’m simply asking for my bill.

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