“How many teeth do you have?” my four-year-old son asked the other day at breakfast.

Thirty-two.

5280 October 2023
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“How many teeth do I have?” my wife responded. “Or how many teeth do you have?”

“Both,” he said. “How many teeth do people have?”

Thirty-two.

My wife explained to him that it’s different for children and adults. That he probably doesn’t have all his teeth quite yet, and that his little brother has even fewer. She didn’t delve into the wisdom teeth of it all. The fact that your deepest, largest teeth will likely one day be wrenched from the back of your skull by a paid professional is a cruel truth we intend for him to learn on his own, like climate change and where babies come from.

“How many teeth do grown-ups have?”

“Thirty-two!” I blurted out, finally voicing the number that was begging to escape my head.

My wife looked at me, skeptically. Why did I have that information so spring-loaded, as if I were just waiting for someone to ask me? I looked at her sheepishly and shrugged. Because I had been waiting for someone to ask me. She shook her head in dismay. Yet another layer to this man she married, this labyrinth of neuroses.

You see, I count my teeth—compulsively. I start in a corner, tap my tongue from the bottom right molar, up to the top right, then on down the line, all the way across to the other side of my mouth. I have no idea how often I do this. If I had to guess or tell a court-ordered therapist, I would estimate 50 times a day. Of course, you would never know. I don’t open my mouth. I’ve trained my jaw to stay still while I do it. Were you to encounter me walking down the street, you would find a seemingly normal person going about his business. You would never know that inside that person’s mouth, a busy tongue flicks deftly betwixt molars and premolars, canines and incisors, left to right, sometimes right to left, down and back, then back again, while the numbers one through 32 clickity-clack through his skull like a delightful, animated segment on a children’s program.

These are your teeth! Just ask Keith! He counts them all the time!

The segment stars a guy named Keith. Keith is neurotic.

“Trust me,” I assured my wife. “It’s 32.”

I wasn’t even cognizant of the fact that I counted my teeth until that exact moment. The behavior is the definition of subconscious. Yet right there, at breakfast, this subliminal truth about myself shot to the surface so vehemently I immediately understood it as well as I had ever understood anything. I count my teeth. All the time. This is my truth. And I felt proud of this newfound truth.

I felt satisfied that my utterly useless tic—one of many caused by my obsessive-compulsive disorder—proved beneficial, that it provided my son with information. He asks 1,000 questions a day. I can barely answer any of them. But here, at long last, was something Daddy knew quite well. Like the back of his teeth. Except I was wrong. Humans have 28 teeth. My wife looked it up on her phone while I was patting myself on the back. It’s 32 with wisdom teeth, but as my son will someday learn on the streets, you usually get those pulled. Like I did way back when.

All this time, all these years that I had been counting my teeth, knowing them better than any human being could ever possibly know his teeth, I was doing it wrong. Despite landing on the number 32 every time I count, I actually only have 28 teeth. As do you. As do most people.

Huh.

I remember the first time I ever heard the word psychosomatic. I was in the Denver office of my childhood pediatrician, Dr. White. I was seven, maybe eight, and I was there because I had been peeing a lot. Like a lot, a lot. So much so that my mother decided to take me to the doctor. But I was only peeing at night, when I was going to bed. I would head to the bathroom before turning in, then head back to bed. Except instead of going to sleep, I would fixate on my bladder.

Surely there’s more pee in there, I would think. A few drops, at least. It’s not completely empty, and it must be completely empty.

After five or 10 minutes of thinking about how I probably needed to pee again, I would need to pee again. So I would. Then 15 minutes later, after similar torment, I’d be off to urinate once more. And so on. Night after night of me trudging to the bathroom, peeing, heading back to bed, repeat.

Imagine your child doing this. Imagine the sounds. The bed springs springing as he gets up. The click of the bathroom door as it opens. The paltry amount of urine hitting the toilet water, then the grunting, the wheezing, as he forces out a few more hard-earned drops. The shuffling of feet as he heads back to bed. The door shutting. The bedsprings springing anew. Then all of it, all over again. And again. For hours.

Can you imagine this symphony? My parents listened to it on a nightly basis in our shared bathroom. Which is how I wound up in Dr. White’s office being told it was all in my head.

The doctor was very matter-of-fact, in my recollection. He assured my mother and me me, no bladder infection, no cancer. I was just mentally torturing myself. My behavior was psychosomatic; I needed to tell my brain to stop telling my bladder it had to pee. I appreciated the way that he treated me like a grown-up that day. He told me I didn’t have to urinate. I told him, I know that, but my brain respectfully disagrees. Then I like to think we shook hands.

But my behavior didn’t stop. For people like me, the behavior can’t stop. These are obsessions. These are compulsions. There is no reasoning with them because there is no reason. Hence the word disorder. So we all just adjusted. Dr. White went back to work, my parents turned the volume up on the television in their room, and I peed as many times as I needed to. Which was a lot.

My first experience spending significant time away from a familiar bed was a nightmare. We were visiting my mom’s side of the family in Virginia, and for five days of our stay, I attended a soccer camp at the University of Virginia. Four boys I had never met and I were placed in a cheap, student-housing condo, where, mercifully, we each had our own room. But the bathroom was shared: multiple sinks, multiple stalls. Self-preservation had me scrambling for the room nearest the bathroom, but that only got me so far. When we all turned in at the same camp-mandated time, the others dreamed of soccer glory, while I envisioned an empty jar filling with liquid, a leaky pipe in some underground tunnel. Then I tiptoed back to the bathroom for another taste of that sweet, sweet pissing. Then I did it again. And again.

One night, a fellow camper opened his door and caught me in the act of traipsing. He was annoyed, sleepless, his face full of what-the-fuck? He had been listening to the machinations of my pee dance for an hour. I told him I was having diarrhea and apologized. He shook his head and shut the door. Humiliated, I peed into my dorm room trash can for the remainder of camp. Every morning, I would make sure I was the last to leave for the day’s training, then I would empty the trash can in the shower, clean it, and return it to my room for the coming miserable evening.

I didn’t go to another soccer camp for years, which undoubtedly hindered my development. Now, whenever someone watches me play in my washed-up indoor soccer league for 40-year-old men at a fitness club in Denver’s Central Park neighborhood, they marvel at my immaculate first touch, my powerful finishes, and my general flair, and they wonder why I didn’t play professionally. I tell them Barcelona was interested in buying me as a boy midfielder, pumping me full of growth hormones Lionel Messi–style, then unleashing me on La Liga, but there was one small problem: Uhh, how you say, “I pissed too much”?

Compulsive nocturnal urination wasn’t my only obsessive behavior. My sisters and I all had tendencies. We collected and shared them, swapped them like OCD trading cards. And you better believe every one of them was in mint condition.

Before my older sister closed her eyes for the night, the last thing she had to see was the window of her bedroom, never the door. Because if the last thing she saw was the door, it meant that, while she slept, someone would pass through that door.

Made sense. I added it to the regimen.

Before my little sister, Lydia, got into a car, she had to touch the door of the car, not the handle. Because if she touched the handle first, the car would crash.

As good a take on how cars work as any! I incorporated that, too.

Lydia also had a tic that was so perfectly her. If she dropped something on the floor—a piece of trash, a Goldfish cracker, a bit of popcorn at the movies—she had to drop another piece so it wouldn’t be lonely.

I still do that to this day.

My bedtime ritual was Victorian in its hysteria. Bedposts counted and recounted. My single pillow was perfectly centered, then recentered, while nondenominational prayers were bestowed upon family members and pets, always in the same order, then reversed, so that nobody received preferential blessing treatment.

Then, of course, the peeing.

I want to say that this all calmed me; that the world was terrifying and chaotic, and that these rituals were my way of bestowing order where I saw none, of asserting control in the face of a dark void. This is the point where I should present facts to you, percentages of the population who suffer from similar symptoms, data from some esteemed psychological journal about the brain chemistry that mandates this behavior. But I don’t know about any of that. I just know there were itches to be scratched, so I scratched them. Whenever they needed me to. And that made them go away. For a while.

Over the years, these OCD rituals mercifully began fading. For the most part. My bedtime ritual grew shorter and shorter. The need to complete each task was less ardent, the burden was lessened. Maybe my brain was filled with other things: classwork, music, girls, sports. Maybe there wasn’t room for the itching anymore. It got crowded out.

But experience tells me that I just received less of an initial dose of neurosis in my genetic makeup. My older sister, too. We grew up, remained powerfully neurotic, but were able to control it, not the other way around. My little sister wasn’t so lucky. She was dealt a heavier dose. As she aged, the compulsions and obsessions got worse. Until she stopped aging.

I remember when she started to spiral, one of her first confessions of torment was how she could no longer read. As she explained it, rather than bouncing from one word to the next, she would scan the individual letters in a sentence, backward and forward, over and over, so exhaustively that she couldn’t make any progress. Hours would pass, and she wouldn’t have finished a paragraph, the urge to revisit the terrain she had just read too strong.

When Lydia was in the psychiatric ward for a mandatory 72-hour hold when she was 27, 28, I can’t recall—toward the end—my older sister and I brought her lunch every day. We sat down and ate with her. We asked her how bad things were getting. Openly, honestly. We didn’t keep anything from one another; we never had. And while she assured us that she wasn’t going to take her own life, that it was bad but not lethal—and we truly believed her—I also remember this terrifying feeling of comprehension. The scary thing wasn’t how little we understood her behavior, but how much we did.

She explained to us that her brain was doing this, her brain was doing that, and she felt powerless to stop it. You could tell she felt guilty about it. Apologetic. She knew we understood, but she also knew we had conquered the same intrusive thoughts, or at least tamed them, and she felt ashamed she hadn’t. We sat there, listening, sympathetic and feckless, completely cognizant of how she felt, yet powerless to do anything about it. We wanted to shake her, to tell her to tune it out, to scratch the itch, if you must, but then move on. But Lydia’s brain chemistry was just ever so slightly different from ours, I suppose. Off by a degree, a nanomillimeter. How heartless. What a cruel dice roll. So, Lydia scratched, and she scratched, and she scratched. Until the wound could no longer heal.

Sometimes I wonder what it is exactly that I’m passing on to my sons—the mental illness pulsing through my lineage, the curse in my blood. When my wife was pregnant, I brought it up a lot. Because I was worried. I didn’t want to harm my children by giving them my genes. My wife talked me through it. What else are you going to do? Lock yourself in your immaculate home and fear the shadows?

We both agreed that my not leaning into my neurotic tendencies in front of our children would be a good thing. No need to swap OCD trading cards like I did with my sisters. No need to tell my kids when we’re shooting hoops that if I make the next trick shot, everyone I love will never have to suffer again. If those thoughts are ever going to enter their heads, they will come from the inside, not from the outside. But as my children have gotten older, I’ve grown less concerned about how my tics may affect them.

And in any case, children have a way of battering your neuroses against the cliffs. We live in Five Points, in a house built in 1906, with loads of original features. My kids couldn’t give a shit. The two-year-old wrenches the pocket doors out of their sliding stalls in the walls, then crashes them into one another with glee; he throws PAW Patrol figurines into the beveled glass, hard. The four-year-old is structurally kinder, but putting things away is far beneath him. No matter how many times we sing the cleanup song, if you walk into our house without giving us a heads-up, it looks like Santa Claus got hit by a bus.

And you know what? That’s fine. Life has become a Melissa & Doug ice cream set with three flavors missing. And as badly as I want to focus on those three wayward scoops, I have to let them go. If I try to maintain the order of my childhood bedroom, my first apartment, the house my wife and I shared before this one, no one would tolerate me. I would be a tyrant shouting orders, the same way those orders were shouted at me, inside of my head, for so long.

Today, my brain allows me to focus on more important things, like raising children kindly and not sweating their constant tiny messes. My brain would rather I be a good dad. And I’m so grateful for that. I know others are not so lucky. And if my brain is going to let me off the hook, I’m not going to beat myself up, either. For not being perfect. For relapsing.

When my wife informed me that morning that people have 28 teeth instead of 32, I thought it was some profound metaphor for how silly this all is. How you think you’re controlling some supposed chaos through OCD tics, but really, they’re controlling you. You’re worshipping a false idol. It felt like this aha moment, and for a brief second, I entertained the notion of never counting my teeth again. But later that afternoon, there I was, darting my tongue around my mouth. Again.

I decided if my brain needs a few olive branches to its former iron rule as part of my current, less neurotic existence, so be it. If I count my teeth compulsively—and incorrectly—big whoop. It’s how I’m wired. And while there’s plenty wrong with that, there’s also nothing wrong with that. I’m not proud of it, but I’m not ashamed. What does any of it matter? Life is so hard; who cares what you tell yourself to get through it? In the end, I’m just doing what anyone is doing, albeit with a heightened degree of compulsion. My mind behaves differently than a lot of others’, but it also is capable of amazing things.

So here I am, writing it all down. Owning it. My name is Adam Cayton-Holland, and although I know I have 28 teeth, it calms me to tell myself I have 32. You would never know that about me unless I told you. Were you to encounter me walking down the street, you wouldn’t know that I’m different from you. You wouldn’t know the neurotic means by which I’m able to function, by which I’m able to focus on loving my sons more than fearing for them. You would merely see a seemingly normal person, doing his best to put one foot in front of the other, as he secretly scratches an itch.

The More You Know

The International OCD Foundation celebrates OCD Awareness Week from October 8 to 14. To learn more about OCD and how to reduce the stigma surrounding it and other mental health disorders, visit iocdf.org.