August 2010  << Back  

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 BOOK REVIEWS

The Thought that Counts: A Firsthand Account of One Teenager’s Experience with Obsessive-Compulsive Disorder

Deepak Prabhakar, MD, MPH

Wayne State University, Detroit, MI, USA

By Jared Kant, Martin Franklin, and Linda Wasmer Andrews. New York, NY: Oxford University Press; 2008; ISBN: 978-0-195-31689-6; pp 169; $9.95 (paperback).


My mentors always stressed the need to learn from our patients. It is our patients who live with disorders and their consequences every day of their lives. I truly believe that our patients are our best teachers—they help us understand their condition from a perspective that no book or expert can. The Thought that Counts happens to be one such enlightening personal account, about Jared Kant, a man with obsessive-compulsive disorder (OCD)—indeed, a debilitating mental illness.

The book is Kant’s personal story, with input from Martin Franklin, a clinical psychologist, and Linda Wasmer Andrews, a journalist who writes about mental health issues. The main body consists of a foreword, a preface, 6 chapters, a section on frequently asked questions, a glossary, and resources.

The Adolescent Mental Health Initiative (AMHI) of The Annenberg Foundation Trust sponsored this book. Dr. Patrick Jamieson from Annenberg Public Policy Center wrote the Foreword, which introduces readers to various initiatives undertaken by the AMHI. The book’s key audience is adolescents struggling with a mental illness. In the Preface, the readers are reminded that the book is essentially a “memoir” of Kant’s struggle with OCD.

In the first chapter, Kant recapitulates the time in his life when he was symptom free and essentially a “normal kid.” He takes us through early warning signs, such as his fascination with the Ebola virus, making an entrance at a “certain angle,” entering and leaving the school building by the same route, and starting to wash his hands more thoroughly. Kant goes on to describe his obsessive thoughts and various compulsive routines, and in this process enlightens readers about the symptoms of OCD in a way that only someone who suffers from OCD can describe.

The second half of the chapter deals primarily with the nuts and bolts of OCD. The discussion around various forms of compulsions and the differentiation from tics is informative, and patients and health care providers alike will find this valuable.

The second chapter deals with Kant’s journey through the diagnosis of OCD and subsequent hospitalization. Kant was first diagnosed with OCD at age 11. And as any 11-year-old would think, Kant also believed that he would take a “magic pill” and his OCD would go away. When this did not happen, disappointment and depression ensued. This part of the account is particularly effective in underscoring the importance of a supportive and nurturing environment for individuals with OCD. Kant’s account of his first psychiatric hospitalization is captivating. It’s remarkable to understand how acts like confiscation of bootlaces and signing a waiver at the time of psychiatric hospitalization can bear a deep meaning for our patients.

Kant recounts his life at home and school in the third chapter. It is worth noting that a simple task like using a combination lock can be challenging for individuals with OCD. Kant’s vivid description of his “meltdown” in the school locker room serves as an important reminder that a crisis may be lurking at any given time; his coach’s sympathetic intervention once again underscores the importance of a supportive environment for our patients. Readers will find the specific tips for compulsions centered on handwriting, reading, and washing valuable. The authors also provide practical, useful information such as patients’ educational rights.

The fourth chapter discusses psychotherapy and medication. Kant takes readers on a voyage through his boarding school experience; his encounters with the school psychologist are interesting. In this chapter, Kant also introduces readers to his comorbid panic attacks, reminding them to have a high index of suspicion for other psychiatric comorbidities when a patient has OCD. Readers will find the description of cognitive-behavioral therapy—particularly exposure and response prevention—informative and interesting. The discussion on paying for treatment and self-help strategies is practical and useful.

In the fifth chapter, Kant describes rituals, routines, and most significantly, recovery. This is the chapter that most readers would love to read; after all, we all want to hear the part of the story that recounts the patient’s success. Reading “staring down OCD” empowers readers, as one begins to see that overcoming disabling symptoms of OCD can be achieved.

The sixth chapter brings to the fore the need for a close confidant for some of our patients, as Kant describes his rewarding romantic relationship with “Megan.” Kant describes Megan as an “OCD veteran” who helped him to overcome his fear at every step of writing this book.

Kant cautions readers about the chronic nature of OCD and recommends that those with OCD return to their health care provider in case relapse is around the corner. The book ends with a section on frequently asked questions about understanding OCD, coping at home, getting treatment, and going to college, followed by a glossary of relevant terms and resources for patients. Readers will find this information instructive and practical.

This book is different from traditional memoirs: In addition to being the life story of an individual with OCD, it is a guide for the signs, symptoms, pathology, treatment of—and recovery from—OCD.

Although the book’s target audience is adolescents with mental illness, in my view, patients’ families and health care providers will also find this to be a valuable text. This book will enhance the knowledge base of its readers by not only enlightening them about OCD as an illness, but also by providing tools, such as glossary of terms and a listing of support organizations with contact information that will help readers in seeking professional help.

In summary, I found this book to be an educative text. It facilitates understanding OCD from a patient’s perspective and highlights the importance of devising patient-centered strategies toward achieving the goals of complete and sustainable recovery.