What happens when you try to treat OCD with psilocybin?

Adam Strauss is He stands in his New York City apartment, clutching the frail headphones cord, trying to decide between the two MP3 players on his desk: an iPod and its Korean counterpart, the iRiver. He plays the same song on each, switching the silver plug of his headphones back and forth like a 1930s keyboard player.

He’s trying different songs, different genres and different instruments. The iRiver tends to sound better overall, but the iPod offers more nuance in the midrange. The iPod has better battery life, but the iRiver still lasts eight hours, which is longer than I can continuously listen to music. Then again, he’s never owned an MP3 player. Is eight hours enough?

It moves back and forth, back and forth, testing audio ranges, button resistance, and interface aesthetics. His internal monologue races like duct tape. Do aesthetics even matter? It will be in my pocket most of the day. I’ve never seen a line out the door to buy an iRiver, but people line up at the Apple Store to get an iPod. Maybe these people know something I don’t know. Or maybe these people are all fools, and pay a premium for a lower quality device!

It would be one thing if it were just Adam deciding which MP3 player to buy. After all, it was 2003, the height of the personal audio revolution, and Adam was a 29-year-old audiophile. But it wasn’t just iPod versus iRiver. For Adam, it was also about other decisions — what shirt to wear to work, what to order for lunch, even which side of the street to walk on.

At one point, in an attempt to simplify the decision-making process of what to wear, Adam bought 11 identical blue button-down shirts. But he soon found differences in the fit and fading of each shirt. He thought there was right Shirt to choose; Every morning he spent 20, 30, then 45 minutes trying to find it. If he could just decide which shirt was the best, he could control his own destiny.

On one level, Adam knew how ridiculous this had become. He wasn’t a fool. He graduated from an Ivy League university and ran his own company, which at the time was the world’s largest digital library of downloadable sound effects. He was educated, talented, and successful, but lately, obsessive-compulsive disorder has been taking over his life.

OCD arises from a complex mix of brain chemistry, genetic predisposition, and environmental factors. But in conversation, Adam compares his OCD to drug addiction. “Heroin is not what opiate addicts are looking for; they are looking for a high. Heroin is the thing that gives them a high,” he told me. “In OCD, certainty is heroin, and euphoria is the short dopamine hit you get when you feel like you’ve found it.”

But with OCD, he didn’t need to go out into the street to get his treatment. The only tools he needed lived in his head. Adam will make his decision.It has to be the iRiver-Then he convinces himself that he doesn’t listen to enough hip-hop. Before he knew it, both boxes were open on his desk and he was moving the headphone cord back and forth again.

Soon Adam was canceling plans with friends, showing up late for work, and spending sunny Saturdays holed up inside his Manhattan apartment. In an attempt to hide his OCD from others, he isolated himself from social situations, which in turn left him more time to spend trapped in his thoughts.

“For addicts, heroin is a huge simplification,” he told me. “All you care about is getting your next fix. Everything else pales in comparison.” For Adam, it was the same in terms of decision making. The rest of life can only begin after knowing which MP3 player is the best. He was stuck in a vicious circle and desperately needed a way out.

The desire for control shapes our decisions, relationships, and perceptions of our environment. Psychologists consider the desire for control to be a basic psychological need. Yes, having control over your life is generally a good thing. But when the desire for control becomes too all-consuming, or when we try to control what we fundamentally cannot control, it can be destructive.