Medical Examiner

Lily Bailey’s Because We Are Bad Made Me Rethink OCD

Seeing OCD through her more gendered lens made me reconsider my own experience of it.

Woman in school uniform covering face, in a repeated pattern on a yellow background.
Photo illustration by Slate. Photo by Thinkstock.

When Lily Bailey was diagnosed with obsessive-compulsive disorder, she had already been silently grappling with it for about 16 years. As a child, she performed painstaking, sleep-depriving rituals to ensure her family’s safety—the mental illness often forces the people who have it to battle intrusive thoughts or urges and to feel they must perform certain actions to alleviate their anxiety. Bailey believed, for instance, that checking on her younger sister Ella in just the right way would keep her healthy and safe: She would count Ella’s breaths and heartbeats and repeat the words best sister ever, performing each task in multiples of three until the entire ritual felt “right.” And as an adolescent, Bailey’s illness compelled her to try to become the perfect girl through an unending chain of mental routines.

In her new memoir, Because We Are Bad: OCD and a Girl Lost in Thought, Bailey chronicles her struggle with OCD. From her dorm beds to her hospital beds, 24-year-old Bailey tells her story with impressive frankness and eloquence. She recalls how severe her symptoms were, even in toddlerhood. The voice in her head demanding she perform compulsions was so strong she thought that that was what other kids meant by “imaginary friends.” She was despondent to see other children grow out of their invisible companions, while hers took up enough space in her head to turn her I into we.

As a child, Bailey believed bad things were happening to the people she loved because she was bad. Her solution, then, was to be perfect. As an adolescent, her compulsions turned inward—she focused her rituals on herself instead of on her family—and her “friend” spurred her to mentally compile lists of all her potentially bad behaviors and to dissect each instance. Early on in Because We Are Bad, Bailey shares a breakdown of one of her lists, formed on her first day of boarding school at age 13:

Our list from today is EHHCSBR:

ENTER: When we came through Wimborne’s main doors, Mum and we were holding our trunk, and we brushed past another girl. Will that girl think we were being a pervert, trying to touch her?

HANDS: Was my hand sweaty when we shook my new housemistress’s hand in the entrance hall? If so, will she think I’m disgusting?

HELLO: When we met Alice, we said ‘hello,’ and she replied with ‘hey.’ Is hello the wrong way to introduce yourself? Will she think we are weird?

She goes on to detail “CSBR,” but you get the idea. This kind of specificity is what makes Because We Are Bad such an expressive, droll, and evocative tale of mental illness. Bailey illustrates her adolescence, coloring it in with dreamy details and wry observations. Though the book is rife with her harrowing experiences, from obsessive fears that she might be a pedophile to psychiatric hospital stays, its overall effect is that of a late-night diner catch-up with a lovable friend. Bailey bares her soul, bouncing between distant dryness and overwhelming sincerity, and all you can do is keep listening while your coffee goes cold. Imagine Girl, Interrupted, as narrated by a very British version of Kristen Bell.

I absorbed Because We Are Bad with little concern for my coffee and increasing fascination with my dinner companion. I was not only struck by Bailey’s unconventional, lyrical style, but also by the gendered nature of her obsessions. Like Bailey, I have dealt with OCD since early childhood, and I wasn’t diagnosed until my late teens. I cannot draw as neat a line between my experiences growing up female and my experiences with the disorder. But reading Because We Are Bad opened my eyes to an entirely new perspective on OCD. It made me wonder how gendered socialization can affect women’s experiences with the illness in a way that I had never previously considered.

For example, Bailey’s concerns as an adolescent correspond strongly with female beauty standards, behavioral expectations, and sexuality. When she was in high school, she developed categories in order to make her lists of letters more manageable: “bodily functions,” “liar,” “boring/loser,” “pervert,” “idiot,” “bitch/unkind,” “rude,” “posh twat/spoiled,” and “selfish.” The bodily functions of an adolescent girl, her need to not seem perverted, and her obsession with kindness all seemed to me to be concerns that could easily be exacerbated by the expectations of the society surrounding her.

Though the memoir never directly states that Bailey’s obsessions are rooted in her gender, I was interested in teasing out this possible connection. I spoke with Bailey over the phone to get her take on some of the book’s more woman-specific moments. “Some of the categories I used were quite gendered,” Bailey mused, game for a contemplative phone interview even at 10 p.m., London time. She hadn’t set out to write a story about how OCD and girlhood shape each other, but she was fascinated by the idea. “With OCD, obsessions often form based on your social and cultural surroundings, so being a girl, I don’t think it’s surprising that, you know, I had things on my list like ‘bitch’ and ‘vain.’ “

One particular passage in Bailey’s book stood out to me in this regard. A scene that takes place when she is just beginning high school reads:

Some men in a van pull up. They are ogling us like there is no one inside our head to notice. We worry that we might get pregnant with their child as a punishment for letting them look when we should be charging out of the car and screaming in defense of feminism.

Bailey wanted to put this memory in her book to demonstrate her irrational adolescent fear of pregnancy. The passage highlights another facet of Bailey’s obsessions, though. As she put it to me, she would agonize over “what it means to be a good girl … to behave and to toe the line.

“If I was walking along the street, if someone wolf whistled at me or catcalled at me, sometimes I would have this obsessive intrusive thought that I had provoked that by making some kind of lurid gesture that I just didn’t remember doing,” she recalled. “It was a similar thing with the pregnancy … Because I guess, on the face of it, it seems so weird that guys would be doing that to me if I hadn’t instigated it in some way. I used to feel guilty about that, and then I’d have this obsession that I’d asked for it without even remembering doing it.”

Women’s bodies, particularly their sexualities, are generally more subject to unwanted attention than men’s. In their paper published by the American Psychological Association, “Sexual Objectification of Women: Advances to Theory and Research,” Dawn M. Szymanski, Lauren B. Moffitt, and Erika R. Carr untangle the ways in which sexual policing adversely affects women on a psychological level. They write, sexual objectification, or “SO,” “occurs when a woman’s body or body parts are singled out and separated from her as a person and she is viewed primarily as a physical object of male sexual desire.” According to them, many women internalize sexual objectification and then develop body shame and anxiety about their appearances as a result. These issues, they argue, can lead to disordered eating, depression, and sexual dysfunction.

I wondered how, or if, a woman’s experience of OCD could potentially be exacerbated by her experience as a woman sexualized by the world—an experience that, though forced on her by our culture, she would nonetheless have to sort out alone. What happens when that woman has an anxiety disorder that causes her to believe she is responsible for things that are out of her control? Could it make her experience of OCD worse? I spoke to Sarah Parker, a director and co-founder of the Reeds Center for outpatient OCD treatment, about what role gendered socialization might play in a patient’s experience with OCD.

“A lot more research, I think, has to be done before we can say there’s a strong cultural influence [on OCD],” Dr. Parker said. “I think what I can say is that … obsessions that people develop tend to be about matters that are really important to them, otherwise they wouldn’t come with that intense feeling of distress … We just can’t say for sure whether those things are more biologically driven or culturally driven, or some combination of the two.”

Depending on the data, women can be as much as three times more likely to develop OCD compared to men. According to a 2007 study by Harvard Medical School, 2.3 percent of the population reported a lifetime prevalence of OCD. But split that data between genders, and the divide is clear—3.1 percent of women have the illness, while just 1.6 percent of men do. Another curious, gendered difference: Though women are more likely to develop OCD than men, men reportedly experience an earlier onset of symptoms.

It’s currently unclear why women have higher incidences of the disease—more research, or rather, any research, is needed. But it certainly seems possible that sexism at least informs some women’s experience of the illness. That’s not to say that men can’t have anxiety over how they look, or how others perceive them—it’s just to point out that women and girls are generally subject to an extremely high level of social scrutiny as a result of their gender. “Sexual Objectification of Women” states:

Research indicates that being sexually objectified is a regular occurrence for many women in the United States. For example, in a series of daily diary studies, Swim and her colleagues found that 94% of undergraduate women reported experiencing unwanted objectifying sexual comments and behaviors at least once over a semester, women reported more SO experiences than men, and SO emerged as a unique factor of daily experiences of sexism.

Lily Bailey came of age in an all-girls boarding school, and she still felt her appearance was heavily policed. “You know, we’re often our own worst enemy, us girls when we’re teenagers, because it is just such a time of insecurity … It’s a hotbed of bitchiness, basically, in an all-girls boarding school,” Bailey told me. She said other girls criticized her androgynous body. “I started to obsess that I was a boy … And so I think there were quite a lot of obsessions that were around the nature of being female, and whether I was female enough.” Her comments made me realize how inextricable the connection between obsessive behavior and culturally encouraged female insecurity can be. Through this lens, the lines between, for example, complex beauty rituals and hygiene-related compulsions become blurrier than one might expect.

In Because We Are Bad, Bailey also writes about her obsessions with feminine beauty standards, particularly in her teenage years. Before attempting suicide at university, Bailey writes, “I shower and shave my legs, because I don’t want the coroner to think I am disgusting.”

She recalls scrutinizing every sound, movement, and smell her body made, and even those it hadn’t (but might). She would track the things she said to other people and the way she looked at others, especially fellow girls, for fear that they might mistake her glances as sexual. Bailey did these things because she wanted others to like her and think she was “good.”

Wanting to be liked is a simple enough task on its face, but it’s an altogether more arduous one for girls and women who are often damned if they do or don’t. Nice girls are fake, mean girls are bitches; sexual women are sluts, chaste women are frigid. It’s no wonder that, as Bailey’s memoir progresses, her lists only become more expansive and unmanageable. Not only do compulsions beget obsessions at a psychological level, meeting the standard for “good” female behavior requires a balancing act of circuslike proportions.

My reading of Because We Are Bad doesn’t mean all girls and women with OCD are so neatly impacted by socialization, or that men cannot likewise have grueling experiences with the illness. (After all, my own experiences of gender and OCD don’t intersect in such perpendicular lines.) Instead, Because We Are Bad raises interesting questions about the relationship between femaleness and obsessive-compulsive disorder—questions that I hope medical studies will begin to answer in the near future. Until more research is done, it’s impossible to say that girlhood exacerbates OCD. Still, it’s easy to see how the two might connect. For women like Lily Bailey, whose obsessions focus on their bodies and sexualities, it must be quite challenging to grow up in a society that, on the whole, tells girls they should constantly self-police their own behavior.

After a lot of therapy and medication management, Bailey manages to conclude Because We Are Bad on a hopeful note. The book itself is likewise an optimistic symbol: In fact, it is the greatest accomplishment of Bailey’s recovery to date. In publishing it, she proves that her story and the people her story might help are ultimately more important than what others may think of her. This lesson will likely resonate with many women who struggle with self-criticism, whether the critical voices in their heads come from mental illness or just from the faultfinding world in which we all live.