Melanie Napp faces nothing more grueling than a weekend camping in Pennsylvania’s Pocono Mountains, but as she unrolls her sleeping bag in a rain-soaked tent at Hickory Run State Park, she has the haunted look of a prisoner forced to build her own gallows. Napp, 31, has obsessive-compulsive disorder, a mental illness whose sufferers are driven by anxiety to become slaves of habit. Her problem is checking mirrors—and checking them and checking them. Until recently Napp, a slim, attractive former Philadephia-area schoolteacher, was so fearful of appearing ugly and unkempt that she went weeks without leaving the house she shares with her mother. “I knew what I was doing was crazy, but I couldn’t stop,” she says. Now, after seven months of therapy, she is about to spend three days in the mud without a compact. “This,” she says, “is my worst nightmare.”
Napp and 11 others afflicted with OCD are here to face their terrors head-on and, they hope, overcome them. The outing was organized by psychologist Jonathan Grayson, 49, who since 1982 has led members of his OCD support group, GOAL (Giving Obsessive-compulsives Another Lifestyle), in a unique rite of passage: an annual camping trip. Water dripping from his Indiana Jones hat, Grayson, who practices in Bala Cynwyd, Pa., summons the troops to the picnic area and goes over the ground rules: No one may perform the rituals with which OCD patients ward off their outsize anxieties; everyone (including Grayson himself and psychologist Lee Fitzgibbons, 41, who helps run the retreat) must participate in all activities, no matter how distressing. “The more you avoid the things you fear,” he says, “the smaller your world grows.”
For most of these campers, the world has grown to be a very small place. A pharmacist beset by multiple compulsions—to avoid dirt and the number 4, to compensate for any steps he takes by taking an equal number in a different direction—hasn’t been away overnight for more than a year. Now, as night falls, he must crawl into a filthy tent. Seeing him shudder, homemaker Gayle Frankel, 58, one of three recovered OCD patients who have come along to help the others, offers empathy. Before her first trip with Grayson’s group 13 years ago, she says, “my idea of camping was driving a Winnebago to the Hilton.”
He doesn’t crack a smile. In fact OCD is not just a matter of absurd fastidiousness. Thought to be caused by a neurochemical imbalance in the brain, the disorder affects an estimated 1 out of 40 people in the United States. Those afflicted can’t stop worrying about the potentially disastrous consequences of a minor loss of control and spend their waking hours trying to keep the dangers at bay. They may wash their hands or check that the stove is turned off hundreds of times a day. Most do their best to hide their condition, though a few celebrities—Howard Stern, Billy Bob Thornton, Howie Mandel—have lately gone public about their ongoing struggles with the ailment. “These are often talented, high-achieving people,” says Grayson. “But they’re really ripped up inside.”
OCD was once considered hopeless. Today, antidepressant drugs alone can help reduce symptoms by 30 to 50 percent. And since the disorder is learned as well as biological (as time goes on, the habits become ever more deeply ingrained), the improvement rate is 70 percent when medication is combined with behavioral therapy. The treatment of choice—allowing many patients to function normally in just a couple of months—is called exposure and response prevention. Explains Grayson: “You say, ‘I’m scared of doing that,’ and we say, ‘Do it!’ ”
Grayson’s version of the technique is the only one known to involve camping out, an activity that requires a total immersion in the kind of grunge that most OCD patients dread. First thing on Saturday morning, he parades his charges to the odoriferous latrines. He asks them to touch the seats and then their faces, then marches them back to make breakfast without washing up. The pharmacist joins in, though his fear makes him vomit. Next comes a 12-mile hike through damp underbrush. “An adventure,” Grayson pronounces, as the campers groan, “is something that sucks until it’s over.”
Grayson’s own trail began in the same Philadelphia suburb where he now practices. His mother was an artist, his father a corporate sales manager, but from the time he heard a psychologist speak at Career Day in eighth grade, that’s what Grayson (who had two older sisters) wanted to be. He majored in psychology at nearby Temple University, taking a summer job cleaning toilets in an office building. “That proved to be a critical part of my clinical training,” he says with a laugh. In his senior year he married his high school sweetheart, Catherine, now 47 and a special-ed teacher. They have an 18-year-old son, Joshua, a freshman at Boston’s Emerson College.
After earning a doctorate in psychology at the University of Iowa in 1979, Grayson did an internship with obsessive-compulsive patients at Brown University, then went to work on a research grant with one of the pioneers of OCD treatment, the University of Pennsylvania’s Edna B. Foa, now 63. He discovered that he liked and admired these tormented souls. “They’re the most caring, tolerant, considerate people,” he says. “Their strength is what makes people not understand them. They look like they’re not in pain.” But the longer he worked with them, the more he realized that OCD patients didn’t need just medication and therapy; they needed one another. In 1981, with organizational help from then-patient Frankel, he started GOAL. The 60-member support group, which still meets biweekly, is chaired by Grayson and is open to any OCD sufferer—not only his patients—free of charge.
“Jon’s ability to help people empower one another is unique,” says Patty Perkins Doyle, executive director of the OC Foundation, a national patients’ advocacy organization. “It’s probably his best healing tool.” One success story is a 65-year-old woman whose terror of pesticides extended even to the word in the phone book. When the sight of an insect-control truck made her drive into a parked car, she joined GOAL. Eight months later she became the manager of an exterminator’s office. She has come along on this trip to embolden others.
The annual journey grew out of an offhand remark Grayson, an inveterate outdoorsman, made at a GOAL meeting in 1981. As members discussed their fears of animals, fire and filth, he declared, “I ought to take you guys camping!” The group accepted the challenge. Almost every year since, Grayson has shepherded his campers—who chip in to pay for provisions and equipment—through the wilderness of their own anxieties.
Sitting by the fire on Saturday night, the pharmacist says, “I slept in the tent and I didn’t go crazy.” A public relations woman afraid of contact with anything that might have touched meat announces that she ate not only the hamburger dinner but a snack of beef jerky. Everyone applauds. Grayson leads a sing-along: “Qué será, será. Whatever will be, will be.” Before they get into their cars the next morning to head back to civilization, Grayson organizes a group hug. “You’re among the bravest people I know,” he says. Bedraggled but glowing, Melanie Napp reports that she no longer misses her mirror. “I’m glad it poured,” she says. “I felt so free.” Then she speaks the thought on every camper’s mind: “I hope I can take this home.”