The main character in the book Turtles All the Way Down is a 16-year-old girl named Aza Holmes who lives in Indianapolis and struggles with all the usual teenage issues like dating, getting along with her parents, friendship and worrying about getting into college. But she is also frequently overcome by dread, anxious about things like whether bacteria will kill her. She can’t control her thoughts and wonders if she can control her life.
Author John Green says Aza’s story is actually his story told in the form of a novel. He describes through Aza the spiraling worries and the obsession with small details that often overwhelmed him. In a New York Times interview Green says even though he has been keeping his life in balance for many years with medication and psychotherapy, there were days, “I couldn’t escape the spiral of my thoughts, and I felt like they were coming from the outside.”
When a person has uncontrollable and recurring thoughts that may include excessive fear of germs or having things in perfect order, those thoughts can lead to repetitive actions like hand washing or repeated checking to make sure items are in an exact arrangement. These obsessions and compulsions might mean constantly checking to see if the door is locked or the stove is turned off.
Routines and habits are normal part of daily life, but when these thoughts and behaviors interfere with functioning and affect work, school or relationships, a person may be diagnosed with Obsessive-Compulsive Disorder.
The National Institute of Mental Health reports OCD can affect adults, adolescents and children. OCD is reported countries around the world. People who have experienced physical or sexual abuse in childhood or other trauma are at increased risk for developing OCD.
Green wrote Turtles All the Way Down based on his own thought and behavior patterns that he realized began when he was six years old. He was afraid his food was contaminated, so he would only eat certain foods and at particular times of the day. And despite years of keeping his anxiety in check with medication and Cognitive Behavioral Therapy, he experienced an episode when he was 24 when he was so overcome by uncontrollable thoughts he couldn’t eat and or make sense of the books he was supposed to be reviewing. Working with a psychiatrist, he found the right medication and went on to write several books, including his most well-known The Fault in Our Stars, which became a movie.
In writing Turtles All The Way Down, Green strives to offer a description of the interior experience of OCD, something which he realizes is difficult to describe. The author does this by letting readers share the teenager’s anguished obsessions.
“I spent a lot of my childhood consumed with obsessive worry and dread,” says Green. He hopes the novel will “...help people who struggle with that terror to feel less alone.” Green says it’s time to erase the stigma often attached to mental health issues like OCD. “I want to talk about it and not feel any embarrassment or shame,” he says.“I think it’s important for people to hear from adults who have good fulfilling lives, and manage chronic mental illness as part of those good fulfilling lives.”
Green has managed his OCD over the years with treatments found to be most helpful for the disorder, including specifically prescribed medication and Cognitive Behavior Therapy. Treatment is often most effective with a combination of medication and psychotherapy. Therapy may be in individual, family or group sessions.
A type of Cognitive Behavioral Therapy found to be effective for many people with OCD is Exposure and Response Prevention. That’s a therapy that involves gradually exposing a person to a feared object or obsession, such as dirt, and learning healthy ways to cope with the anxiety. The therapy can take effort and practice, but it can help people enjoy a better quality of life.
Here are some recommendations from the Mayo Clinic that can add regularity and a positive perspective when living with OCD.
Alter, Alexandra, “John Green Tells a Story of Emotional Pain and Crippling Anxiety. His Own.” New York Times, Oct. 10, 2107
National Institute of Mental Health, “Obsessive-Compulsive Disorder,” January 2016
Mayo Clinic, “Obsessive-Compulsive Disorder,” 2018