“I heard about [Pure O] and instantly there wasn’t any doubt in my mind,” he told the BBC’s How Do You Cope podcast. “I said: ‘That’s it. That’s what’s going on. That’s what I’m experiencing.’ In hindsight, this is something that I had my whole life.” Ezra has sought therapy, and says the condition has influenced his songwriting.
Pure O, short for “purely obsessional”, is not yet recognised by doctors as a medical term – instead, it emerged from OCD sufferers themselves to describe a form of OCD that is marked more by thoughts than by actions.
When we think of OCD, we usually think of irrational behaviours like washing your hands again and again, or turning a light switch on and off dozens of times to stop your family from dying. But people who say they have Pure O say they experience unwanted, distressing thoughts without the physical actions designed to relieve them.
And these “intrusive thoughts”, as they are called by doctors, can be terrifying. Peter Klein, a psychotherapist in Richmond, west London, says one of his patients used to have the same mental image, again and again, in which she stabbed her baby and partner, even though she had no ill feelings towards either. Another “very common one” is for patients to become terrified they might be a paedophile, even though they have no reason to think so.
“Usually, the intrusive thought will relate to something that’s most important to them,” he explains. “Someone may walk past a child, and think, ‘Oh, I noticed that child, why did I notice them?’ You probably just noticed them because they walked past. But they think: ‘How do I know that I didn’t notice them because I like children, how can I be sure of this?’”
Intrusive sexual thoughts – like heterosexuals who are afraid of ‘turning out’ to be gay, or married people who are terrified of being attracted to a friend – are particularly common, as explored by Channel 4’s recent provocative drama, Pure.
Everybody has the occasional intrusive thought. Have you ever stepped onto a railway platform and suddenly wondered what would happen if you jumped in front of a train, for example? But Pure O sufferers say they encounter these distressing thoughts constantly, and they are often haunted by the horrific mental images they summon.
Shuttleworth says his OCD can be triggered by something as simple as unloading his dishwasher. “If I’m putting knives or scissors away, and I’m near my wife, sometimes I think: ‘Am I going to stab my missus?’ I have no compulsion to, it’s more the fear of the image. That’s something I get quite often.”
Doctors are sceptical that Pure O is a distinct strain of OCD. Klein thinks the very name Pure O is a “misnomer”, because even those of his patients who think their illness is “purely obsessional” still tend to carry out some form of cleansing action. A married straight man might become convinced against all evidence that he is gay, for example, and so will ‘test’ their theory by re-examining in their head all of their recent encounters with men. This mental ‘test’ is itself a form of behaviour. “There are compulsions involved, not only obsessions, so it’s not really ‘pure’ O,” Klein says.
Prof Gus Baker, trustee of The Brain Charity, says: “‘Pure O’ OCD is a relatively new term, coined by the individuals who have it. Many doctors do not currently use the term when making diagnoses.” A patient who says they have Pure O, he adds, “would still likely be treated using standard, traditional treatment methods, the same that are used for other types of OCD”.
Regardless, some patients maintain that the term is a helpful way of explaining that OCD does not necessarily mean obsessive cleanliness, and occurs mostly within one’s own head. Ezra’s most debilitating fear is that he will say the ‘wrong’ thing in a social situation, for example – a remarkably common hang-up for OCD sufferers, especially among Ezra’s millennial generation, whose constant exposure to social media may well have made them more attuned to others’ opinions.
Gaby Hasham, 25, who works for a mental health charity in London, says her own Pure O reared its head in her final year of Durham University, when she began to obsessively replay virtually every conversation, terrified of the idea that she might have offended one of her friends or relatives.