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Social & Cultural Geography, Vol. 5, No. 4, December 2004 RoutledgeTaylor Ei Francis Croup

Disturbing geography: obsessive-compulsivedisorder as spatial practice

Jeremy Segrott* & Marcus A.'School of Health Science; ^Department of Geography, Swansea University, UK

This paper explores the spatial practices of obsessive-compulsive disorder (OCD). It beginsby introducing the key elements of the disorder: obsessions and compulsions. It thenconcentrates on obsessions and compulsions relating to fears of bodily contamination. Suchfears necessitate the formation of psycho-social boundaries in tuays that are similar toagoraphobia and other mental-health problems. Avoiding bodily contamination alsoinvolves complex spatial orderings to prevent the illicit movement of contaminants. Thevital importance, yet fragile nature, of these spatial formations means that negotiatingsocial space and interactions can be immensely fearful, and tbe OCD sufferer may retreatto the relative safety of home. Hotvever, the domestic is a space of ambivalent safety.Everyday objects become saturated with fear, transforming tbe experience of 'home'.Boundaries and spatial orderings are transgressed in the movement of people and objects.Thus, the OCD sufferer is driven to (re)order space constantly, and in doing so often useseveryday materials in inventive ways. We critique the depiction of OCD as irrational andexcessive, and set the creative practices of OCD in relation to the 'slippage' of Michel deCerteau's distinction between spatial strategies of domination and the art of tactical living.

Key words: obsessive-compulsive disorder, mental-health, spatial practice, domestic space,consumption.

IntroductionA different world ... slips into ... place, (de Certeau1984: xxi)

This paper explores the quotidian world ofobsessive-compulsive disorder (OCD), a moreor less debilitating anxiety disorder with adisturbing geography. Our interest in OCDstems from the personal experience of living inclose proximity to someone with the condition,and a more general interest in the often fraughtrelationship between subjectivity and space,and the pathological nature of modernity and

postmodernity as socio-spatial formations(Clarke and Doel 1997; Doel 2001; Doel andClarke 1999; Doel and Segrott 2003a, 2003b).However, it is not the intention of the presentpaper to read the ambient fear and diffusedis-ease that haunts modernity and post-modernity into the experience of OCD. Astempting as such a reduction might be, 'Thedrawback, though, is that this approach seemsto attribute to ... sufferers an insight they don'thave' notes Carter (2002: 209). 'It risks dis-counting the suffering, the actual, chronicallydebilitating unease'. Consequently, the paper

ISSN 1464-9365 print/ISSN 1470-1197 online/04/040597-18 © 2004 Taylor & Francis Ltd

DOI: 10.1080/1464936042000317721

598 Jeremy Segrott & Marcus A. Doel

offers an original perspective on OCD by fo-cusing precisely on the embodied practices thatliving with the disorder requires.

Given our commitment to the experience ofOCD, our concern here is not with how thedisorder is caused, treated or overcome. Wefocus instead on what people 'do' with theirobsessions and compulsions, and the ways inwhich such forms of action take place in andthrough particular spatial formations (Freestonand Ladouceur 1997). We begin by introducingOCD and outlining the two key elements of thedisorder: obsessions and compulsions. Our dis-cussion then concentrates on a particularlycommon and highly geographical form of thedisorder: obsessions and compulsions regardingbodily contamination, with particular referenceto domestic space. Three key geographicalthemes are developed throughout the paper:firstly, the formation of psycho-socialboundaries for the maintenance of self-identity;secondly, the organization of space for thecirculation of things; and, thirdly, OCD as acreative form of practice. Our concern withhow particular spaces are experienced andused, and the role that they play in the con-struction of self-identities, engages with thegrowing corpus of work on the geographies ofmental health. At the same time, in exploringOCD as a form of spatial practice we disturb anumber of academic boundaries and make con-nections between areas of human geographicalinquiry that often remain 'curiously isolated',to use a term employed by Wolch and Philo(2000). Thus, our consideration of OCD ex-plores the painful emotions of fragile pyscho-social boundaries with reference to what arenormally considered mundane, everyday prac-tices such as grocery consumption. Equally, ourconcern with the phenomenology and experi-ence of OCD acknowledges the capacity andagency of non-humans that can disrupt or en-hance human spatial orderings. OCD raises

important questions for a range of geographers,including those interested in the connectionsbetween health and place, the experience ofdomestic space (Domosh 1998; Dyck 1995;Moss 1997; Rose 2003), emotional geographies(Anderson and Smith 2001), consumer society(Clarke, Doel and Housiaux 2003) and materialpractices more generally. By way of conclusion,we critique the frequent depiction of OCD asirrational and excessive, and set the creativepractices of those suffering from OCD againstthe 'slippage' of de Certeau's (1984) distinctionbetween spatial strategies of domination andthe art of tactical living.

Obsessive-compulsive disorder as spatialpractice

As its name implies, there are two distinctelements to OCD: obsessions and compulsions(Toates, 1992). While both elements are nor-mally co-present and linked, obsessions andcompulsions sometimes exist independently ofeach other. According to de Silva and Rachman(1998: 3), 'an obsession is an unwanted, intru-sive, recurrent, and persistent thought, imageor impulse. Obsessions are not voluntarily pro-duced, but are experienced as events that in-vade the person's consciousness ... Anobsession is a passive experience: it happens tothe person'. Indeed, the word 'obsession'derives from the Latin obsidere, to besiege.However, a person with OCD typically realizesthat the obsessions are internally derived: theobsessional thoughts, images and impulses be-long to them, and are not implanted from anexternal source. Although individuals mayknow that their obsessions are excessive oreven irrational, repressing them often producesextreme discomfort, and overt resistance fre-quently wanes with time. In extreme cases,obsessional thoughts, images and impulses can

Disturbing geography 599

become virtually all-consuming and thoroughlydebilitating. In the context of OCD, then, ob-sessions have nothing whatsoever to do withthe colloquial usage of the term to denote anabsorbing passion into which the subject entersfreely (although see Baudrillard 1996, on thepathology of collecting).

Obsessions relate primarily to the preventionof danger, especially the fear of harming one-self or others, and they generally produce feel-ings of anxiety, guilt and even panic. Theircontent commonly includes contamination, ill-ness, violence, death, destruction, disorder,asymmetry, immorality and blasphemy. Mostobsessions have an external or internal 'trig-ger', thus differentiating OCD from more gen-eralized 'over anxiety'. For example, obsessionswith death could be triggered by seeing akitchen knife or a 'mental event', such as re-membering a deceased relative (de Silva andRachman 1998).

Compulsions are forms of behaviour—suchas washing, cleaning, checking, counting,touching, hoarding, arranging and ruminat-ing—that a person is driven to perform, oftenin direct response to obsessional thoughts, im-ages and impulses.' Where compulsions ac-company obsessions, they tend to have twoprimary goals: to neutralize the anxiety or dis-comfort produced by an obsessional thought,image or impulse; and to prevent the outcomeor disaster that the obsession portends. Littlewonder, then, that compulsions, like obses-sions, are never pleasant, and frequently ac-quire a repetitive and ritualistic nature whichcan itself be endlessly prolonged and refined.

Most compulsions are overt bodily actionsthat are visible or audible (e.g. touching andwashing), and which are highly geographical inthat they involve using space in particular ways(e.g. arranging and hoarding). Other compul-sions are covert or purely mental acts (e.g.counting and ruminating). Tallis (1992: 10)

suggests that 'sometimes, [compulsive] behav-iour is completely irrational, and resembles asuperstitious ritual. Other kinds of compul-sions are related more logically to the obses-sion, but are clearly excessive'. However, whilecompulsions can often be rationalized and nat-uralized in relation to obsessions (e.g. washingto cleanse or checking for safety), it is crucialto appreciate that the person does not chooseto behave in this way. Compulsions must beperformed. So, while certain forms of OCDmay appear to demonstrate little more than anexcess of action (e.g. too much washing andtoo much checking), which is often counterpro-ductive and frequently ineffective (because theaction is itself deleterious or simply misguided),it is important to recognize that compulsionsare not in and of themselves functional. One iscompelled to act—irrespective of whether ornot one wants to act; and irrespective ofwhether or not the circumstances 'objectively'necessitate such action. This is why the connec-tion between obsessions and compulsions isneither causal nor functional, but arbitrary andcontingent; why one can experience 'pure' ob-sessions and 'pure' compulsions; and why OCDis so resistant to a rational discourse of moder-ation and efficacy. So, while the differencebetween housework and compulsive cleaningmay appear to be a difference of degree, thereis also a difference in kind in play: the differ-ence between efficacy and excess is over-deter-mined by the difference between choice andnecessity.

Although the content of OCD has changedtemporally, with fears regarding asbestos dur-ing the 1970s giving way to concern about HIVand AIDS by the 1990s, OCD appears to be aglobal dis-ease, present in many parts of theworld (de Silva and Rachman 1998; Rapoport1989).While the 'classic' form of OCD is quitestable (obsessions and/or compulsions are al-ways present), the content of the obsessions


and compulsions may relate to almost any facetof existence, and Lemelson (2003) suggests thatthe 'symptomatic expression' of OCD may beshaped by cultural factors. There is also someevidence to suggest that the impact of OCD onquality of life and social functioning is context-dependent (Bobes et al. 2001). Despite the sem-blance of a coherent 'illness' with a stable set ofsymptoms, OCD is in reality uniquely consti-tuted through each experience of the disorder.Moreover, while most people with OCD tendto have one type of obsession, it is not uncom-mon for them to experience multiple obses-sions, for their primary obsession to shift overtime, and for the disorder to be associated withother mental and personality disorders (Rapo-port 1989). The disorder affects both men andwomen in fairly equal numbers, although thereis confiicting evidence regarding the proportionof men and women experiencing particularkinds of compulsive behaviour (Franzblau,Kanadanian and Rettig 1995). Adolescence andearly adulthood are the key periods duringwhich OCD is most likely to develop (de Silvaand Rachman 1998), and its onset is especiallyassociated with traumatic stress (de Silva andMarks 1999); although OCD can present itselfat different times in the life-cycle, such asduring pregnancy and childbirth (Baer andJenike 1990). However, Franzblau, Kanadanianand Rettig (1995: 100) suggest that OCD is inmany ways an 'enigmatic' illness, with 'littleinformation that allows a valid determinationof the racial or social class makeup of personswith OCD'.

Despite the fact that OCD involves complexexperiences and practices, studies of the dis-order by geographers and other social scientistsare virtually non-existent. The extensive clini-cal literature on OCD often draws upon indi-vidual case studies, but, as Parr (1999) rightlynotes in relation to other mental-health prob-lems, this is primarily to assist in the isolation

of the disorder, the identification of its etiologyand the determination of effective therapeuticinterventions. The tendency to describe typicalsets of obsessions and compulsions risks over-looking the highly individualized nature ofOCD (but see Rapoport 1989, which blendsclinical and experiential material). Conse-quently, Franzblau, Kanadanian and Rettig(1995) critique the dominance of reductionistmodels based primarily on the overproductionof the neurotransmitter serotonin to explainOCD (cf. Castle and Groves 2000).^ They arguethat

[BJeyond issues of etiology ... a model which empha-sizes [the] meaning and value of these behaviourswould enable us to understand why these behavioursare so resistant to treatment ... [They] have meaningand value in the context of a person's attempt toadapt their response to a particular environment ass/he perceives it. (Franzhlau, Kanadanian and Rettig1995: 104)

Compulsions should therefore be seen as mean-ingful practices designed to regain a sense ofbeing in control of one's external environmentwhen this has been lost. The interaction be-tween self and environment, and the suggestionthat OCD is often context-specific, clearly un-derline the complex geography that is in play.The frequent recourse to schemas of typicalobsessions and compulsions within many ac-counts of OCD also risks presenting the dis-order as an abstract set of symptoms, ratherthan thoughts or practices that take place andunfold within the context of everyday life andwhich interact with the other aspects of peo-ple's lives and identities. Franzblau, Kanada-nian and Rettig (1995: 100) suggest that 'Inpatients whose OCD was classified as episodic,rather than continuous or deteriorative, thesebehaviours were in many cases viewed by


patients as adaptive and integrated into theirlives' (see also Seedat and Stein 2002).

Having introduced OCD, in the rest of thepaper we explore some of the spatial practicesthat constitute obsessions and compulsions re-garding bodily contamination. We base ouraccount on a range of sources, including ma-terial provided by self-help groups, the clinicaland self-help literatures on the disorder, andthe personal experience of an OCD sufferer.Indeed, our initial interest in OCD emerged asa result of living in close proximity to Jane, awoman in her late twenties who has sufferedfrom the disorder for approximately ten years(a pseudonym is used to maintain her anon-ymity). Our discussion of Jane's experience isbased primarily upon one of the authors' per-sonal refiections. We have also discussed thespecific concerns and argument of the paperwith Jane, including the way in which she hasbeen presented and her experience of OCDinterpreted.

Geographies of germs: OCD, bodies andboundaries

Like many others who suffer from OCD, themain theme of Jane's obsessive thoughts is thatshe will contract a fatal illness (or cause othersto do so) by coming into contact with germs orbacteria. Such contamination can be direct (e.g.a drop of polluted rainwater falling on tosomeone) or indirect (e.g. someone touches adoor-handle that has been contaminated bypolluted rainwater). The slightest physical con-tact can cause cross-contamination, and onlythe smallest amount of contaminated materialneeds to be involved (e.g. a single particle ofdust or a molecule of mercury). For some OCDsufferers with this manifestation of the dis-order, contamination takes place through prox-imity as well as physical contact. For others.

the mere sight or even knowledge of a contam-inant is enough for contamination to take place(e.g. looking at dustbins or thinking aboutthem). Whilst some OCD sufferers may be ableto explain the process by which contaminationtakes place, this is not always so, as Stanley, ateenager suffering from the disorder, makesclear. 'Don't ask me why or how something gotto be impure; I don't know why, it just felt thatway' (Rapoport 1989: 131).

However contamination comes about, an ob-ject will remain contaminated until properlydisinfected, a process which is often as muchsymbolic (and ritualized) as material. ThusJane's compulsions are either preventative orundertaken to disinfect an object (or the self)when contagion occurs, thereby rectifying thesituation. These compulsions involve washing,cleaning, ordering and maintaining barriers be-tween herself and sources of contamination byusing rubber gloves and kitchen roll. In theabsence of adequate containment and decon-tamination, an endless process of indirectcross-contamination is set in motion throughwhich germs and danger proliferate rapidlyuntil there are literally 'germs everywhere'(Thomsen 1999). This proliferation is both spa-tially extensive (from object to object) andpsychologically intensive (a heightening of anx-iety, fear and discomfort). Jane's OCD waxesand wanes, and although it intrudes perma-nently upon certain activities (e.g. handling rawmeat), for much of the time daily life can befaced with relative ease. Nevertheless, therehave been periods when her OCD has becomemore debilitating: the frequency and intrusive-ness of obsessive thoughts have increased, andthey have spread to more and more activities.Everyday life sometimes becomes almost im-possible, and a great deal of Jane's time isdevoted to ensuring that she does not becomecontaminated. At such times of heightened anx-iety, Jane has been unable to


leave home except for the most urgent of tasksand only feels truly safe in bed.

A point often made in the clinical literatureon OCD is that it involves an exaggerated senseof self-responsibility, the origin of which isspecific to each individual (de Silva and Rach-man 1998; Wilson and Chambiess 1999). Whilstthe responsibility for the initial creation ofcontamination and its subsequent proliferationthrough space and time may lay in the hands ofa range of actors, to blame others serves nouseful function in the context of OCD. Theindividual must defend his or her own bodilyboundaries, and avoid acting as a conduit forthe onward spread of contamination that mightharm other people. Compulsions are thereforecreative in the sense that they compel the self totake some form of overt, covert or mentalaction to re-order the chaotic circulation ofcontaminants initiated by others.

Insofar as this form of OCD revolves aroundthe contracting of an illness through physicalcontact, a key aspect of contamination compul-sions involves erecting and defendingboundaries: around the self, but also around arange of objects, people and spaces experiencedas contaminated.^ Work by Davidson (in rela-tion to agoraphobia) and Parr (on delusionalexperiences) has highlighted the way in whichmental-health problems disrupt both bodilyand psychic boundaries. Davidson (2000a: 641)suggests that agoraphobia may involve the dis-solution of the boundary between 'inner selfand 'outer world', and the inability of theindividual to project their presence into thesocial space that they (and especially others)inhabit. In one account, a respondent describesexperiencing confusion

in the boundaries of her phenomenal body, an intol-erable and unsustainable confusion of internal andexternal space. She clearly loses the ability to projecta protective boundary around herself, and as a

result, is both assaulted by external space, crumblinginwardly under its pressure, and unable to preventinternal space from exploding outwards. (Davidson2000a: 650)

Similarly, in discussing the psychic spatialitiesof delusional experiences. Parr (1999: 679) sug-gests that 'disrupted identities, as related byparticipants ... were very much tied to the lackof a sense of psycho-social borders andboundaries'. An individual may experiencetheir inner self as unbounded and immense,even while their physical body may be placedwithin the confined space of a hospital ward ora prison cell. In both cases, the authors suggestthat regaining one's boundaries may help re-store feelings of ontological security. Despitethe fact that obsessions often invade or besiegeconsciousness, OCD does not typically involvethe disruption of psycho-social boundaries. Theself remains bounded and coherent, and itsinterface with the natural and social environ-ment is not significantly altered. In other ways,however, there are strong similarities with theaccounts discussed by Davidson and Parr. Theboundaries of the self are under perpetualthreat from outside forces and must be con-stantly monitored and maintained. Jane wasintensely distressed by being forced into physi-cal contact with other bodies, coats, bags andexhalations whilst travelling on a crowded bus,and was immensely worried that she wouldcontract some form of illness. On leaving thebus she became convinced that she had steppedin dog excrement on the pavement, and wasoverpowered by a sense of invasion and con-tamination. Reaching the safety of home, shestopped in the hallway, scared of entering therooms of her house for fear of contaminatingeverything she touched. Taking a pair of rub-ber gloves from her shopping bag she cau-tiously removed her shoes and clothes, placedthem in a bin bag, and wept uncontrollably.


Unable to cook the food that she had boughtfrom the supermarket because it had been con-taminated, she retreated to bed.

One way of protecting the self from contami-nation is to avoid spaces experienced or per-ceived as dangerous (Tallis 1992). Given thehighly individualized composition of obses-sions, the kinds of spaces and places experi-enced as dangerous or contaminated varywidely. For instance, de Silva and Rachman(1998) describe a young woman's fear of excre-ment which led her to avoid public toilets andsewer covers. This strategy of spatial avoidanceaccords with the cases recounted by Davidsonand Parr. For example, agoraphobics mayavoid being in public spaces where they feelunable to maintain their psycho-socialboundaries or the specific locations where theyhave previously experienced panic attacks.

Within the context of OCD, all places aredirty to a greater or lesser extent, and even themost hygienic of spaces contain significantamounts of polluting material. Although someplaces are experienced as dirty in an absolutesense, the fear of dirt may be linked as much tothe way in which it is managed, as to itspresence. In those spaces that are well ordered,objects are arranged so that contamination can-not be put into circulation. People's interac-tions with such objects are also ordered in sucha way that cross-contamination does not occur,especially through practices such as hand-wash-ing and the adoption of a strict sequencing ofhousehold activities. Thus, when 'correctly' or-dered and confined, dirt does not become con-tamination. Dirty objects (such as shoes) can betolerated as long as they are located in 'proper'relation to other objects, and people handlethem in a 'safe' way. Douglas (1966: 36) arguesthat the notion of 'dirt as matter out ofplace ... implies ... a set of ordered relationsand a contravention of that order. Dirt... isnever a unique, isolated event. Where there is

dirt there is a system. Dirt is the by-product ofa systematic ordering and classification of mat-ter'. For Douglas (1966: 2), therefore, 'dirt isessentially disorder'. In well-ordered environ-ments the self may interact relatively freelywith the social and physical world whilst main-taining effective boundaries against germs andbacteria because the prospect of proliferouscontamination is brought under control. Al-though such a disciplining of space is invariablyidiosyncratic, not least because it reflects aspecific combination of obsessions, compul-sions and triggers, it nonetheless accords withthe more familiar subject-centred dis-enchant-ment and rationalization of the world that hasbeen the hallmark of modernity. Our objectswere meant to be 'de-spiritualized, de-ani-mated: denied the capacity of a subject' (Bau-man 1992: x). The most frightening of spacesare therefore those that are disordered (andthereby re-enchanted and re-animated), notnecessarily those places that we commonlythink of as inherently dirty. For Jane, the localpublic library became a space of anxiety be-cause books were in constant circulation and incontact with people, shopping, animals andother household objects. She perceived the pro-liferation of dirt and germs as being so rapidand immense to the point where it was imposs-ible to comprehend—let alone control—thepresence of danger. Public spaces more gener-ally are often very traumatic for people withOCD. It may be impossible to maintain aprotective zone or barrier between the self andother bodies and objects. People disrupt the'proper' spatial order. They break down andinvade the bounded, protected self, and precipi-tate an illicit circulation of materials. 'Dirty'objects come into contact with 'clean' ones,and contaminants consequently proliferateeverywhere. In this sense, OCD may be seen asconstituting a heightened sensitivity to theways in which other people make use of, and


project themselves into, space. Franzblau,Kanadanian and Rettig (1995: 101) suggest that'obsessive ritualizers may be more sensitivethan others to their environment ... overly sen-sitive to stressful events ... needing to establisha certain environment'. Again, the similaritieswith agoraphobia are striking.

[W]hen the agoraphobic leaves home, space ceasesto be subjective. Sufferers are too highly sensitized tothe ways in which space is charged by others; it thusbecomes corrosive or, we might say, abject, a termJulia Kristeva uses to denote that which we must'radically exclude' from ourselves, but which is al-ways present, threatening to invade us and causinganxiety. (Davidson 2000b: 34)

Such a magnified state of sensitivity makes itvery difficult to habituate social relations andspatial practices. Those who suffer from OCDneed to be eternally vigilant against the ambiv-alence and duplicity of people and things. Theyare burdened with a responsibility that canbecome absolutely overwhelming, not least be-cause it is extremely difficult to delegate suchintense vigilance, even to the most 'trusted' ofothers (people, sensors, machines, routines,etc.). This can devastate social relationships,which invariably require reciprocal acts of en-trustment in order to endure. Indeed, OCD canbe so acutely distressing precisely because thosewho suffer from obsessions and compulsionscan trust neither the world, nor others, noreven themselves. Little wonder, then, that somany of those who endure OCD come to relyon a kind of self-conscious acting out of au-tomatism which is all too liable to crash: theprogrammatic execution of exacting and ex-haustive routines which have very little to dowith instrumental rationality and functionalefficacy. For example, consider a 'number rit-ual', based on the figure 4: 'I pull my chair inat the table four times, recite in my head four

different prayers four times, use the pepperfour times, putting it on four different placeson my plate, put my knife and fork down fourtimes during the meal, chew the food fourtimes or in multiples of four' (personal accountin de Silva and Rachman 1998: 40).

Kirby (1996: 99) suggests that '[T]he problemwith space isn't just space; it is the fact thatthere are other people in it—other people whoare creating it, determining it, composingit...[I]s it surprising then, that space couldseem a bit hostile?' To which Davidson (2000b:33) responds: 'Her statement implies that spaceis somehow charged, populated with the con-structions of others. Most of the time, mostindividuals are quite literally impervious tothese unwholesome attributes of space'. Likeagoraphobics, then, OCD sufferers are alsoacutely sensitive to the spatial practices of oth-ers, which perpetually risk conflicting withtheir need for a 'proper' organization of things.However, we would concur with Carter (2002)that this spatiality concerns more thanboundary disputes (between inside and outside,private and public, self and others, clean anddirty, etc.). Anxiety disorders are profoundlyconcerned with the circulation of things: '[A]little step always potentially slipping away'(Carter 2002: 92). Accordingly, in the remain-der of the paper we will consider the spatialityof OCD in terms of both boundary disputesand the circulation of things.

Domestic geographies

In the personal accounts of agoraphobia anddelusional experiences discussed by Davidsonand Parr, the avoidance of fearful, mostly pub-lic, spaces is frequently accompanied by a re-treat into the relative safety of the home.Domestic space offers protection from otherpeople's presence, judgements and disorderli-


ness, and allows the self to re-establish itsboundaries and coherence. In the case of OCD,domestic space may also offer the possibility ofmaintaining the protective barriers of the self:of creating a 'protective zone' against thesources of dirt that might invade it (Lupton andMiller 1992). However, this is not to say thatthe 'retreat' into domestic space involves adisengagement from the world and a descentinto passivity. For whilst certain facets of thehome may offer feelings of safety (the ability toshut the world out), in other ways the domesticis no less dangerous in terms of the presence ofdirt than public places. Boundaries and spatialorderings have to be achieved and worked at(Law 2000), and the home, far from offeringthese things as a matter of course, merelyprovides an environment in which such spatialpractices might be more successful and its spa-tial formations might endure. OCD involvescreative practices and complex interactionswith people and objects. This is underlined byParr's (1999) account of delusional experienceswhich connects 'psychic geographies' (thespaces of the inner self) with social space andthe material world.

'[D]elusional geographies' are disruptive spatialitiesproduced by, and experienced within, the mind-body(crudely speaking, 'internal' spaces). They are also,however, experiences which are physically located inmaterial spaces and comprise particular sorts ofrelationships with existing objects, people, and insti-tutions (crudely speaking, 'external' spaces). (Parr1999: 676)

For those people who obsess about contami-nation, the domestic arena is one of the fewcontexts where effective boundaries can be heldin place, and where space itself can be orderedwithout the disruptive intrusion of others. Dirtand other sources of contamination can be keptout through reinforcing the external boundaries

of the house, thus making the domestic a safespace, de Silva and Rachman (1998) and Thom-sen (1999) cite several examples of people whorigidly policed who and what could enter thedomestic sphere. Certain visitors were barredfrom entering the home because they weredeemed to carry germs. Items such as schoolbooks and outdoor clothing had to be de-posited in the garage upon returning home.Inside the house, strong boundaries were main-tained between rooms, thus regulating bothwhat kinds of activities may take place indifferent parts of the home, as well as themovement of people and objects between them.Thomsen describes the case of a 17-year-oldman who

would shower for at least half an hour in order toleave his home to go to school and go to bed atnight. If for some reason he was interrupted in hisshower ritual, he would not permit himself to sleepin his own bed, but would sleep in a sleeping-bag inthe hall. This was to ensure that germs were nottransmitted to the rest of the house. More often thannot he would, during the course of the day, onlypermit himself the use of the hall, kitchen and hisown room. If, for example, he were to enter thelounge, he would spread germs there. (1999: 18)

In short, an order of sorts can be establishedand maintained within the home. Objects, andpeople's interactions with them, can be ar-ranged in such a way that contamination doesnot spread, and those household items withwhich the self comes into intimate contact canbe kept clean. For instance, the mother of anOCD sufferer describes how 'Jenny would getvery upset if her things were touched by any ofus ... Her towel is kept well away from theother towels in the bathroom, her soap is keptin a paper bag, separate, and her toilet paper iskept in a bag, separate ... Jenny's chair at thedining table is kept covered with a sheet and


her plate, mug, and cutlery are kept separate ina drawer' (cited in de Silva and Rachman 1998:52). Jane described how her compulsive clean-ing in the home is driven exclusively by theneed to protect the self, and not by a positivedesire for spatial cleanliness per se; a kind ofspecificity also discussed by Rapoport (1989).''At one time Jane could only operate lightswitches when holding a piece of kitchen paperso as to prevent contaminating her hands. Onceused in this way, however, Jane was unable toput the contaminated paper into the rubbishbin because such an operation would involveexcessive bodily contact with contaminatedmaterial. Consequently, contaminated paperswere simply thrown away from the body,which resulted in them accumulating on thefloor. Whilst this practice may be viewed asunclean from the perspective of householdmaintenance, from the point of view of theobsessive-compulsive body it effectively putcontaminated material in its place.

Broken boundaries and the disordereddomestic

At best, home is a place of relative safetycompared with the disordered, intrusive publicworld because bodily and spatial boundariescan be more effectively maintained, and spacecan be ordered to minimize the risk of contami-nation. However, the domestic may also beexperienced in more negative ways. Whilst cer-tain inherent facets of domestic space offerfeelings of safety (e.g. being bounded by itswalls), other aspects of the 'ontological secur-ity' experienced at home only exist as a resultof effort (e.g. keeping doors, windows and lidsclosed).

The disorder has the potential to transformradically the nature of everyday 'domestic rou-tines and spaces' (Parr 1999: 682). Seemingly

mundane objects and activities become riddledwith fear, and they demand enormous amountsof time and energy over and above that whichis 'normally' expended on them. Indeed, it isimportant to recognize that our objects andpossessions demand a significant amount of ourlabour. Whether one likes it or not, one mustattend to the world around us. 'Enormous as isthe labour we expend to produce all theseobjects, it is probably exceeded many times bythe sheer drudgery of organizing them, main-taining them, cleaning them, storing them, dis-posing of them', notes Levin (1996: 33). ForJane, home became a place of considerablefear, a place where she was forced to touch rawmeat and vegetables, outdoor shoes, carrierbags and incoming mail. So, whilst the homemay be a place of relative safety and security, itcan also be the locus for a range of otheremotions, including anxiety, fear and panic.The disruption of commonly held understand-ings of everyday spaces and practices is vividlydescribed in Valentine's (1998: 321) personalaccount of harassment.

[I]t is into this meaningful space [the home]—whichI considered a more or less impermeable bounded,safe environment, of which I was in total control—that hate mail, calls, and nighttime disturbanceshave intruded. The letters and calls have disruptedthe taken-for-grantedness of my domesticlife ... Simple objects (the envelope), everydaysounds (the phone ringing), have taken on newmeanings, meanings laden with threat, potent with

Another reason why the home may become aspace of fear is because, as Law (2000: 135)notes, '[I]t takes some effort ... to buildboundaries and to keep them in place'. Intran-sitivity is the rule, rather than the exception.Maintaining a bounded, protected self requiresan intricate set of spatial practices concerning


precisely which objects the body may touchand exactly how such contact is to be managed.Yet these systems rarely work in practice be-cause the rules are absolute, and everyday lifecould not continue without some deviationfrom them. Shoes have to be handled. Dirtyclothes have to be touched. Even the act ofdecontamination may involve spreading germs,through the cross-contamination of soaps, tapsand towels. Since no irrelative position can everexist, the self is always in and of the world, andit is therefore impossible to withdraw to aplace of ultimate safety. Our very being in theworld involves physical and psychological con-tact with the objects, people and spaces aroundus. For Jane, certain zones of the body werenever considered to be completely clean be-cause of their endless physical contacts with theexternal world, thus indicating the intricate,multiple and often unachievable rules of OCD.During a particularly traumatic period, Janefelt that she must not touch any item of foodwith her hands that she then went on to placein her mouth (e.g. crisps, biscuits and sweets).

Despite vigorous attempts, the domestic israrely—if ever—turned into a sealed-off space.The physical boundary of the house fails toprovide a total barrier against the intrusion ofcontaminants, with its holes, pipes and cracksthrough which disease-carrying rodents, insectsand dust motes can enter. The house is alsoquite legitimately a place of circulation formail, shopping, rubbish, public utilities and,perhaps most importantly, people (Christensen,Allison and Jenks 2000). Other people maybring contamination into the domestic sphereon their own bodies, and through the articlesthat accompany them, but also by disruptingspace, by misusing it in various ways and bymisplacing objects around the home. WhereOCD sufferers share domestic space with oth-ers (such as family members), particularconflicts may arise. Faced with the spatial dis-

ruptions set in train by others, the OCD suf-ferer is faced with two equally challengingstrategies to pursue. They may abandon theattempt to keep the domestic safe, and retreatinto an even smaller parcel of space (typically abedroom or even a bed).^ Alternatively, peoplewith OCD may seek to continue with theattempt to order domestic space by askingcohabitants either to comply with particularsystems and compulsions or to participate ac-tively in them (Cooper 1996; Waters and Bar-rett 2000).

As we have seen, the relative safety of thehome depends in large part on the ability toimpose a certain kind of order on the materialworld, and the way in which people engagewith it. Objects need to conform to a particularspatial system of arrangements, relations, sepa-rations and boundaries that is meant to keepthe fabric of the world in its place. Thesespatial systems must contend with a world ofobjects that increasingly possesses a life and anaffective potential of its own (Rose and Thrift2000; Thrift 2002; Thrift and French 2002).Despite the best efforts of modernity to disen-chant, objectify and rationalize the worldaround us, our objects no longer seem willingto play dead. For example, as alienated com-modities, many household items are intenselyambiguous, offering few clues to their trajec-tory through space and whether they are indeedsafe or contaminated (Baudrillard 1996). Onceinside the home, the attempt to order objects—to make them passive and well behaved—maybe subverted or transgressed (Cresswell 1996;Sibley 1995). The vacuum cleaner is an excel-lent example, an object which to most peoplesymbolizes containment and cleansing, but forJane it is a fearful object because it dispersesdirty air and dust throughout the spaces it isused in.

Faced with permeable boundaries, the dis-ruptive spatial practices of others and the


transgressive capacity of the material world,one is left with a stark choice—to abandononeself to risk and fate or else to renew contin-ually order and boundaries, taking endless, per-sonal responsibility for the prevention ofcontamination. A range of normally mundaneobjects can be utilized to re-establish control,to negotiate the dangerous world of contami-nated objects and to bring comfort, reassuranceand relief from anxiety. It is here that we mayneed to be especially open to the range ofemotions beyond anxiety and fear that per-meate OCD, though whether compulsive be-haviour can ever produce feelings ofsatisfaction or pleasure is a moot point. Al-though such practices may be saturated withfear and anxiety (the latter because one is neversure where contamination may be), these usesof materials are also arguably creative, a factwhich puts the compulsive body into proximitywith that of the consumer. Objects that arecommonly thought of as mundane (and with asingle use) can nevertheless be used in manydifferent ways, often to the consternation ofmanufacturers and those with a vested interestin promulgating a 'correct' and 'good' use forthings. For instance, 'A fourteen year oldboy... [who] feared breathing "other people'sair", which he thought would be full of infec-tious germs ... was compelled to wear a crashhelmet, complete with visor, to protect himselffrom the breath of other people' (Thomsen1999: 18-19). For de Certeau, consumption iscreative, productive and full of possibilities.Users (i.e. consumers) always have a margin offreedom to act otherwise. Invariably, they pre-fer not to use things in the way that producersexpected. They make use of things. They ap-propriate what appears alienable, and in sodoing they turn the world to their advantage{detournement).

So, whilst contamination-based compulsionsmay appear entirely goal-directed and highly

unpleasant, they also harness everyday materi-als in inventive and creative ways. Perhaps oneof the most important uses of materials in thisrespect is to maintain spatial boundaries whenthe self is forced to handle contaminated ob-jects. Kitchen roll is an immensely useful ma-terial that can be employed to form a protectivebarrier around the self when opening doors,picking up the mail or using the telephone.Whilst kitchen roll is commonly considered tobe a household item that absorbs moisture,here it possesses the power to bring feelings ofrelief, comfort and security. The use of materi-als to maintain order also extends to the widerspace in which one lives, thus re-orderingspace, clamping down on the proliferation ofgerms and allowing the self to re-engage moreeasily with its surroundings. Jane made surethat cracks and holes in the walls of her flatwere covered with parcel tape to prevent crea-tures from invading or at the very least toindicate that they had done so. Similarly, sheused empty spring-water bottles (perceived assafe) to store her toothbrush and to guardagainst infection from rats. In the move topacify objects (and deny them their own will),the material world is simultaneously per-sonified. The world consists of alienable andestranged objects of fear (to be repressed, con-trolled and cleansed), and simultaneously anarray of materials that are clean, safe, usefuland productive. Products that are sterile andsealed are especially helpful items since theycan be used with the minimum of bodily con-tact and then immediately thrown away. IfBuck-Morss (1994) is right to suggest that fash-ion has become our collective tempo of history,such that built-in obsolescence has supplantednatural decay in virtually every domain, thenone might suggest that waste disposal is thetempo of OCD. In both cases, '[OJbjects arediscarded before they decay. Material thingsfall away from the present with a speed faster


than their natural dechne' (Buck-Morss 1994:14).

Conclusion

In this paper we have sought to foreground theeveryday practice of living with OCD. Forwhilst the disorder produces intense emotionsof anxiety, fear and discomfort, it also fre-quently engenders creative forms of action. Aswell as a general openness to the 'livedness' ofOCD, geographers are well placed to examinethe relations between the embodied self and anaffective environment that are a fundamentalaspect of the disorder, and its often situation-specific manifestation. A geographical analysisis also fruitful because of the way in whichobsessions and compulsions are embeddedwithin the spaces and practices of everyday lifeand have the potential to transform them rad-ically. As we have seen, boundaries and regi-mentation are difficult to sustain and must becontinually worked upon. Just as obsessionscan transform 'harmless' artifacts into sourcesof deadly contamination (telephones, tooth-brushes, mail, dust motes, etc.), compulsionscan find creative uses for materials such asparcel tape and kitchen roll to restore orderand bring about relief. Home may become aspace of complex and intense emotions, rang-ing from feelings of safety and comfort to thoseof pain, fear and entrapment. The multipleworlds of OCD point to the fact that suppos-edly mundane spaces and practices can be satu-rated with emotions and feeling (Anderson andSmith 2001). Our argument is that many of thespatial practices that constitute OCD (as withother kinds of material practice) are neitherpurely functional nor especially symbolic: theyare first and foremost affective, rather thaninstrumental or meaningful (Doel and Segrott2003b; Thrift 2002; Thrift and French 2002).

The spatial practices of OCD demonstrate all-too-vividly that the non-human world shouldnot be regarded as a passive collection of ob-jects which human subjects control and drawupon to sustain a sense of an embodied ident-ity. In the world of OCD, as in the realm ofspatial practices more widely, a body is definedthrough its relations (Doel 1995). FollowingSpinoza, Deleuze (1992: 625) argues that firstand foremost, a body 'is composed of aninfinite number of particles; it is the relations ofmotion and rest, of speeds and slowness be-tween particles that define a body, the individu-ality of a body. Second, a body affects otherbodies, or is affected by other bodies'. Livingwith OCD is a profound illustration of such aconception of the body as an articulation ofaffective relations. One's being-in-the-world isforcefully felt.

As we noted at the outset of this paper,many accounts of OCD highlight its suppos-edly abnormal, irrational and seemingly excess-ive nature (e.g. Thomsen 1999). Yet these sameaccounts also point to the fact that the obses-sions and compulsions present in OCD are'normal' in that they are experienced to a lesserdegree by most, if not all of us. For Rapoport(1989: 178), it is difficult to determine 'wherethe obsessionality of everyday life leaves offand OCD begins'. In most clinical accounts,'normal' obsessions and compulsions 'becomeOCD' when they begin to hamper significantlya person's ability to conduct his or her every-day life (de Silva and Rachman 1998). Thus,OCD is defined not by the irrationality oruncontrolled nature of its obsessions and com-pulsions, but by the way in which they crosscertain quantitative and qualitative thresholdsof intensity and intrusiveness. Parr (1999) ar-gues that we need to challenge dualisms such asnormal/abnormal and consider instead mentalhealth in terms of a complex continuum ofstates of being. Echoing such comments, David-


son suggests that because agoraphobia is anexample of quotidian fears in an extremelyheightened form, it provides us with a windowon to aspects of life that we tend to take forgranted.

[T]hose 'boundary' problems experienced by [agora-phobic] sufferers are neither so unique, nor sobizarre if we choose to understand them in terms ofa pathology of everyday life and existence. We arenot Cartesian subjects. There are no fixed and im-mutable boundaries between the self and world. Theself is a project that needs to be constantly renegoti-ated. (Davidson 2000a: 655)

The intricate hand-washing and decontami-nation rituals employed by some people withOCD might well be seen as excessive, irrationaland counter-productive. Yet, viewed as formsof practice designed to take responsibility forthe minimization of risk, they may find an echoin what are commonly viewed as rational dis-courses. For instance, the UK's Food StandardsAgency informs caterers that '[I]f hands aren'tclean they can spread food poisoning bacteriaall around the kitchen. But a quick rinse won'tmake sure they're really clean. So it's importantfor you and all your staff to know how to washyour hands properly'.* Faced with the problemof profusion—the problem of consumer culturepar excellence—obsessions and compulsionsare aligned with necessity rather than choice.Like kleptomania in the nineteenth century(Camhi 1993), OCD takes possession of thesubject. By exploring its practices more closelygeographers may be able to make an originalcontribution to the understanding and appreci-ation of the disorder. In addition, by holdingon to the specificity of OCD we can also saysomething much broader about the oftentaken-for-granted ways in which we inhabitour bodies, construct boundaries and makecreative use of the world around us.

By focusing on the creative dimension ofliving with OCD we have sought todistance ourselves from the view that peoplewith OCD are deprived of their abilityto resist the overwhelming power of obsessionsand compulsions. For although theymay be compelled to act, the specificity of theiractions could always have been otherwise. In-deed, we are struck by the contingency ofobsessions and compulsions, and their mutabil-ity over space and time. Rather than speak ofpower and resistance, we find it preferable todraw on de Certeau's (1984) more subtle dis-tinction between two ways of being in theworld: 'strategies' and 'tactics'. Strategies rep-resent a desire for power and mastery, which isexpressed in the passion for arranging, order-ing, controlling and dictating. Taken together,these strategies constitute a 'calculus of force-relationships which becomes possible when asubject of will and power... can be isolatedfrom an "environment." A strategy assumes aplace that can be circumscribed as proper', anda subject that can be circumscribed as pro-prietor (de Certeau 1984: xix). de Certeauderives several consequences from this desire toinflict such strategies on social space. First,space is made functional and instrumental. Itbecomes an adjunct (property) of the con-trolling power, which distributes itself through-out such a space. Second, these strategies tendto enforce a mastery of space through sight,thereby instituting a passion for surveillanceand surveying. Finally, these spatial strategiestransform uncertain time into readable space.They still life and inaugurate a dead geographyexemplified by the empty structures of puregeometry. As the strategic forces of rationaliza-tion, dis-enchantment and de-animation beardown on the world as never before, it is notsurprising to hear de Certeau (1984: xiv) insistthat


[I]t is all the more urgent to discover how anentire society resists heing reduced to it, whatpopular procedures (also 'miniscule' and quotidian)manipulate the mechanisms of discipline and con-form to them only in order to evadethem ... deflecting their functioning by means of amultitude of 'tactics' articulated in the details ofeveryday life.

In stark contrast to strategies of domination,tactics constitute 'a calculus which cannotcount on a "proper" (a spatial or institutionallocalization) [nor "proprietor"], nor thus on aborderline distinguishing the other as a visibletotality' (de Certeau 1984: xix). These tactics ofimpropriety—of deviation, displacement andtransformation; of bricolage, detournement andseduction—allow one to live again in theworld. To borrow a fine phrase from Bourdieu,tactics are the 'ground of habitude'. Let usclose this paper, then, by simply noting that theambivalence of those who endure OCD shouldcaution us against the current vogue for tooreadily denouncing the desire for strategic con-trol and for too hastily affirming the art oftactical living, de Certeau (1984), Carter (2002)and countless others are right to insist on thefact that life slips by. The problem that facesthose who endure OCD, however, is that some-times life does not slip into place, but that itslips out of place.

Acknowledgements

We are especially grateful to Jane for her par-ticipation in this study. Thanks are due toCavin Andrews, Wil Cesler, Jeanette Hewitt,Robin Kearns, Hester Parr and to the partici-pants at the Emotional Ceographies conferenceheld at Lancaster University for their helpful

comments and suggestions on an earlier versionof this paper.

Notes

1 See Obsessive Action untitied information leaflet (2000).Available from Obsessive Action, Aberdeen Centre, 22—24 Highbury Grove, London.

2 Of course, this is not to deny that individuals who haveOCD frequently engage with health-care professionals,scientists, allopathic drugs, and complementary andalternative medicine, each of which has an affective andperformative specificity all of its own.

3 In a very different context, Wilton (1998: 173) exploresconnections between individual identities and socio-spa-tial orderings, and argues that 'because people internalizesocial norms as a condition for subjective becoming,their own sense of identity is to some extent dependentupon the maintenance of surrounding social and spatialorder'. These issues are drawn out through the exampleof local residents' reactions to the siting of an AIDShospice in Los Angeles. For Wilton (1998: 181), negativeattitudes that encompased fears of proximity and con-tamination 'implied a challenge to the existing socio-spa-tial order, felt concomitantly at the level of individualidentity'.

4 Although Jane believes that her identity as a womanhelps shape her experience of living with OCD, it isimportant to avoid drawing a causal connection betweencompulsive cleaning and the domestic roles traditionallyperformed by women in many Western societies. Jane'scleaning compulsions are driven by an obsession con-cerning the protection of the self and others. Further-more, contamination-related cleaning is a feature ofOCD in many men who suffer from the disorder.

5 Even this strategy is not always practical. Rapoport(1989) recounts the experience of a man who felt unableto keep his apartment sufficiently clean, and thereforeresorted to sleeping in local parks and streets. Not onlydoes this highlight the spatial specificity of OCD, but italso underlines the ambivalent nature of the comfort thathome provides. '[A]lmost every cleaner or washer tellsme that being outside or in some public room is almostalways easier because those places are "already dirty" '(Rapoport 1989: 137). However, for Jane at least, homeis a space of safety when compared with public places.

6 See http://cleanup.food.gov.uk/data/handwashing.htm(accessed 23 November 2004).


References

Anderson, K. and Smith, S. (2001) Editorial: Emotionalgeographies. Transactions of the Institute of British Ge-

ographers 26: 7—10.

Baer, L. and Jenike, M. (1990) Introduction, in Jenike, M.,Baer, L. and Minichiello, W. (eds) Obsessive-Compulsive

Disorders: Theory and Management (second edition).London: Year Book Medical Publishers, pp. 3-9.

Baudrillard, J (1996) The System of Objects, trans. Bene-dict, J. London: Routledge.

Bauman, Z. (1992) Intimations of Postmodernity. London:Routledge.

Bobes, J., Gonzalez, M., Bascaran, M., Arango, C , Saiz, P.and Bousono, M (2001) Quality of life and disability inpatients with obsessive-compulsive disorder, European

Psychiatry 16: 239-245.

Buck-Morss, S. (1994) Fashion in ruins: history after thecold war. Radical Philosophy 68: 10-17.

Camhi, L. (1993) Stealing femininity: department storekleptomania as sexual disorder. Differences 5: 26—50.

Carter, P. (2002) Repressed Spaces: The Poetics of Agora-

phobia. London: Reaktion.

Castle, D. and Groves, A. (2000) The internal and externalboundaries of obsessive-compulsive disorder, Australian

and New Zealand journal of Psychiatry 34: 249-255.Christensen, P., Allison, J. and Jenks, C. (2000) Home and

movement: children constructing 'family time', in Hol-loway, S. and Valentine, G. (eds) Children's Ceogra-

phies: Playing, Living, Learning. London: Routledge,pp. 139-155.

Clarke, D. and Doel, M. (1997) Transpolitical urbanism:suburban anomaly and ambient fear. Space and Culture

1: 13-36.

Clarke, D., Doel, M. and Housiaux, K. (eds) (2003) The

Consumption Reader. London: Routledge.

Cooper, M. (1996) Obsessive compulsive disorder: effectson family members, American Journal of Orthopyschi-

atry 66: 296-304.

Cressweil, T. (1996) In Place/Out of Place: Geography,

Ideology, and Transgression. London: University of Min-nesota Press.

Davidson, J. (2000a) A phenomenology of fear: Merleau-Ponty and agoraphobic life-worlds. Sociology of Health

and Illness 11: 640-660.Davidson, J. (2000b) '...the world was getting smaller':

women, agoraphobia and bodily boundaries. Area 32:31-40.

de Certeau, M. (1984) The Practice of Everyday Life, trans.Rendall, S. Berkeley: University of California.

de Silva, P. and Marks, I. (1999) The role of traumatic

experiences in the genesis of obsessive-compulsive dis-

order. Behaviour Therapy and Research 37: 941-951.

de Silva, P. and Rachman, S. (1998) Obsessive-Compulsive

Disorder: The Facts. Oxford: Oxford University Press.

Deleuze, G. (1992) Ethology: Spinoza and us, in Crary, J.

and Kwinter, S. (eds) Zone 6: Incorporations. New

York: Zone, pp. 625-633.

Doel, M. (1995) A hundred thousand lines of flight: a

machinic introduction to the nomad thought and scrum-

pled geography of Gilles Deleuze and Felix Guattati,

Environment and Planning D: Society and Space 14:

421-439.

Doel, M. (2001) la Qualified quantitative geography. En-

vironment and Planning D: Society and Space 19: 555—

572.

Doel, M. and Clarke, D. (1999) Dark panopticon. Ot,

attack of the killer tomatoes. Environment and Planning

D: Society and Space 17: 427-450.

Doel, M. and Segrott, J. (2003a) Self, health, and gender:

complementary and alternative medicine in the British

mass media. Gender, Place and Culture 10: 131—144.

Doel, M. and Segrott, J. (2003b) Beyond belief? Comple-

mentary medicine, lifestyle magazines, and the dis-ease

of everyday life. Environment and Planning D: Society

and Space 21: 739-759.

Domosh, M. (1998) Geography and gender: home again.

Progress in Human Geography 11: 276—282.

Douglas, M. (1966) Purity and Danger: An Analysis of

Concepts of Pollution and Taboo. London: Routledge.

Dyck, I. (1995) Hidden geographies: the changing life-

worlds of women with multiple sclerosis. Social Science

and Medicine 40: 307-320.

Franzblau, S., Kanadanian, M. and Rettig, E. (1995) Cri-

tique of teductionist models of obsessive-compulsive dis-

otder: towatd a new explanatory paradigm. Social

Science and Medicine 41: 99-112.

Freeston, M. and Ladouceur, R. (1997) What do patients

do with their obsessive thoughts?. Behaviour Research

and Therapy 35: 335-348.

Kirby, K. (1996) Indifferent Boundaries: Spatial Concepts

of Human Subjectivity. New York: Guildford Press.

Law, J. (2000) Transitivities, Environment and Planning D:

Society and Space 18: 133-148.

Lemelson, R. (2003) Obsessive-Compulsive Disorder in

Bali: the cultural shaping of a neuropsychiatric disorder,

Transcultural Pyschiatry 40: 377-408.

Levin, C. (1996) Jean Baudrillard: A Study in Cultural

Metaphysics. Hemel Hempstead: Prentice Hall.

Lupton, E. and Miller, J. (1992) The Bathroom, the

Kitchen and the Aesthetics of Waste—A Process of

Elimination. New York: Kiosk.

Moss, P. (1997) Negotiating spaces in home environments:older women living with arthritis. Social Science and

Medicine 45: 23-33.

Parr, H. (1999) Delusional geographies: the experientialworlds of people during madness/illness. Environment

and Planning D: Society and Space 17: 673—690.Rapopott, L. (1989) The Boy Who Couldn't Stop Washing.

New Yotk: E. P. Dutton.

Rose, G. (2003) Eamily photographs and domestic space: acase study. Transactions of the Institute of British Geog-

raphers 28: 5-18.

Rose, G. and Thrift, N. (eds) (2000) Special issue: spaces ofperformance, part 1, Environment and Planning D: So-

ciety and Space 18(4).Seedat, S. and Stein, D. (2002) Hoarding in obsessive-com-

pulsive disorder and related disorders: a preliminaryreport of 15 cases. Psychiatry and Clinical Neurosciences

56: 17-23.Sibley, D. (1995) Geographies of Exclusion: Society and

Difference in the West. London: Routledge.

Tallis, F. (1992) Understanding Obsessions and Compul-

sions: A Self-help Manual. London: Sheldon Press.

Thomsen, P. (1999) From Thoughts to Obsessions: Obsess-

ive Compulsive Disorder in Children and Adolescents.

London: Jessica Kingsley.Thrift, N. (2002) Closer to the machine? Intelligent environ-

ments, new forms of possession and the rise of thesupertoy. Cultural Geographies 10: 389-407.

Thrift, N. and Erench, S. (2002) The automatic productionof space. Transactions of the Institute of British Geogra-

phers 27: 309-335.Toates, E. (1992) Obsessive Compulsive Disorder: What It

Is—How to Deal with It. Wellingborough: Thomsons.

Valentine, G. (1998) Public/private voices—'sticks andstones may break my bones': a personal geography ofharassment, Antipode 30: 305-332.

Waters, T. and Barrett, P. (2000) The role of the family inchildhood obsessive-compulsive disorder. Clinical Child

and Family Psychology Review 3: 173-184.

Wilson, K. and Chambiess, D. (1999) Inflated perceptions ofresponsibility and obsessive-compulsive symptoms. Be-

haviour Research and Therapy 37: 325-335.Wilton, D. (1998) The constitution of difference: space and

psyche in landscapes of exclusion, Geoforum 29: 173—185.

Wolch, J. and Philo, C. (2000) Erom distributions of devi-ance to definitions of difference: past and future mentalhealth geographies. Health and Place 6: 137—157.


Abstract translations

La geographie perturbante: le trouble obses-sionnel compulsif comme pratique spatiale

Cet article etudie les pratiques spatiales dutrouble obsessionnel compulsif (TOC). II de-bute par un survol des principaux aspects dutrouble en termes d'obsessions et de compul-sions. Par la suite, il met I'accent sur les obses-sions et les compulsions relatives aux craintesliees a la contamination corporelle. Ces craintesexigent que des frontieres psychosociales seforment selon un mode qui rappellel'agoraphobie et les autres problemes de santementale. Les moyens d'evitement de la con-tamination corporelle s'accompagnent aussid'agencements complexes de l'espace pour pre-venir le mouvement illicite de contaminants. Lafragilite de ces formations spatiales d'une im-portance vitale implique que I'engagement dansl'espace social et les interactions peuvent etredes experiences tres angoissantes. Ceux quisouffrent du TOC chercheront done a serefugier dans leur domicile qui est relativementplus securisant. Toutefois, l'espace domestiqueoffre une securite qui est ambivalente. Les ob-jets de tous les jours sont empreints de senti-ments de peur qui bouleversent I'experience du«chez soi». Les frontieres et les agencementsspatiaux sont enfreints par le mouvement desgens et des objets. Par consequent, ceux quisouffrent du TOC sont pousses a (re)ordonnercontinuellement l'espace et, ce faisant, iis seservent d'objets de tous les jours avec beaucoupde creativite. Nous critiquons la representationdu TOC comme etant irrationnelle et excessive,et situons les pratiques creatives associees auTOC en rapport avec l'idee de «glissement»;dans la distinction que propose Michel deCerteau entre les strategies spatiales de ladomination et l'art de la vie tactique.


Mots-clefs: trouble obsessionnel compulsif,sante mentale, pratique spatiale, espace domes-tique, consommation.

Geografia perturbadora: trastorno obsesivo-compulsivo como practica espaciai

Este papel explora las practicas espaciales deltrastorno obsesivo-compulsivo. Empieza porintroducir los elementos principales deltrastorno: obsesiones y compulsiones. Luego secentra en las obsesiones y compulsiones enrelacion con el miedo a la contaminacion delcuerpo. Este tipo de miedo exige la formacionde fronteras psicosociales parecidas a las deagorafobia y otros problemas de la salud men-tal. Evitar la contaminacion del cuerpo suponeun orden espaciai complejo asi para impedirque los contaminantes se muevan ilicitamente.La importancia, y sin embargo la naturalezafragil, de estas formaciones espaciales hacenque la negociacion de espacios sociales e inter-acciones sean aterradoras, y la persona que

padece del trastorno muchas veces se retira a laseguridad relativa de la casa. Sin embargo, elespacio domestico es de seguridad ambivalente.Objectos cotidianos llegan a ser saturados en elmiedo y, de este modo, transforman la experi-encia de 'casa'. Con el movimiento de personasy objetos las fronteras y el orden espaciai estantransgredidos. Esto empuja a la persona quepadece del trastorno a poner el espacio enorden constantamente, y al hacerlo muchasveces utiliza materias cotidianas con inventiva.Hacemos una critica de la representacion deltrastorno como irracional y excesivo y anal-izamos las practicas creativas del trastorno enrelacion con el 'bajon' de la distincion que haceMichel de Certeau entre las estrategias espa-ciales de dominacion y el arte de una vidatactica.

Palabras claves: trastorno obsesivo-compulsivo,salud mental, practica espaciai, espacio domes-tico, el consumo.

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Disturbing geography: obsessive-compulsive disorder as ...home.cc.umanitoba.ca/~hallmanb/files/GEOG4290-readings-pdf/segroff... · as washing, cleaning, checking, counting, touching,