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problem for arachnophobes when they are in the presence of spiders. Someone with paraskevidekatriaphobia, a fear of Friday the 13th, is truly a paraskevidekatriaphobe for only a couple of days or so a year. In phobias, the feared stimulus is external. But in OCD it comes from within, from our own thoughts.
    Obsessions and phobia can, however, focus on the same fear. In the 1980s, Andy Warhol had a persistent dread of HIV, which the artist called the ‘magic disease’. He refused to eat sandwiches prepared by another gay man and when his partner Jon Gould developed pneumonia in 1984, Warhol told his housekeepers to wash their clothes and dishes separately. Given what was known and not known about Aids at the time, it’s hard to see Warhol’s fear as completely irrational. He certainly didn’t think it was. He didn’t fight the thoughts. And that means that he probably didn’t have OCD.
    Overlap between phobia and OCD exists for a more primitive terror. In the early 1960s, clinical psychologists at a mental hospital in Warrington near Liverpool treated a middle-aged American woman obsessed with a fear she would be buried alive. To stop this from happening, the woman wrote detailed instructions of how her body should be cut up after her death and left several copies of these notes around her house so they would be discovered if she died. Each night she had to compulsively check these instructions were in place before she could sleep. Sometimes she would spend so long on these pre-sleep checks that she never went to bed at all.
    Was her fear irrational? Like Warhol, the woman could have argued not. Her obsessions and compulsions began when she read a newspaper story of a man closed up in his coffin while he was still alive. Tales of premature burial were common in the past, and inventors fitted coffins with bells and whistles and other ways for the revived deceased to draw attention from underground. Many countries in Europe passed burial laws in the eighteenth and nineteenth centuries to ensure that corpses were kept above ground for enough time to give the not-really-dead time to come round.
    George Washington and Frederic Chopin shared this fear of being buried alive – formally known as taphephobia – and it was common for people to include in their will requests for candles and mirrors to be held to their dead mouth to detect breathing, while others asked to be decapitated or stabbed through the heart before they were placed inside their coffin. The famous will of Alfred Nobel, the Swedish inventor of dynamite who pledged his fortune to set up the academic prizes that bear his name, ends with the words:
    Finally, it is my express wish that following my death my veins shall be opened, and when this has been done and competent doctors have confirmed clear signs of death, my remains shall be cremated in a so-called crematorium.
    Crematorium owners did well from taphephobia.
    As well as being an obsessive-compulsive, the woman in Warrington was claustrophobic. She could not ride in an elevator or an underground train or sit in a locked room. The psychologists thought they could treat her compulsions if they eased her phobia. If she was not frightened of small and enclosed spaces, they reasoned, she would not need her grisly instructions and her nightly checks on them. They were wrong. Months of treatment at Winwick hospital, now a housing estate that overlooks the M62 motorway, cured her of the claustrophobia, so much so that she could sit inside a closed cupboard. But she never lost her obsessive-compulsive fear of an early grave, and could never sleep until she had made sure she would not wake up in one.
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    Given cases like these, it’s perhaps tempting to see obsessions and compulsions as a modern complaint, yet another manufactured condition of the pampered and self-indulgent postwar generations with little more serious to concern them than whether they left