Since he was 9 years old, Mario Della Grotta has been consumed by compulsive thoughts for at least 18 hours a day.
"It was literally a full time job for me to live," he said.
Even something as common as brushing his teeth in the morning became complicated.
"I would start brushing my teeth, once, twice, three times," Della Grotta said. "I would shower, it never felt right. I would shower a second time."
OCD, also known as Obsessive Compulsive Disorder, fueled his extreme cleanliness and counting rituals.
"A lot of Mario's behaviors, his rituals, were mental rituals," said Sheri Della Grotta, Mario's wife. "They weren't always apparent to the casual observer."
A simple task like shopping would throw Della Grotto into a state of confusion.
"My mind was always constantly racing," he said. "I couldn't stop checking. I couldn't stop counting."
Della Grotta said if he spent $37 of $100, he would go to another store and spend $20.
"After I went from store to store, I would start from the beginning again -- $40 here, $20 here, $19 here," Della Grotta said.
It became so extreme, Della Grotta even considered suicide inside the mall where his OCD would spiral out of control.
"It was too difficult for me to continue to live like that every day of my life," he said. "I looked over the balcony and I said, 'If I was to jump, my OCD would end.'"
Psychiatrist Dr. Ben Greenberg, who works at Butler Hospital in Providence, R.I., said when he first met Della Grotta, he was despondent, profoundly demoralized and couldn't interact in his marriage.
"He really was disabled by the severity of the OCD," Greenberg said.
In fact, Della Grotta's case was the most extreme the doctor said he had seen.
Medicines and traditional therapies to treat OCD failed Della Grotta. So, Dr. Greenberg recommended a radical procedure -- deep brain stimulation, or DBS, in which electrodes are inserted into the brain and connected to a small pacemaker-type device implanted in the chest.
The pacemakers send electrical currents deep into the brain's circuitry, blocking the signals thought to be responsible for OCD.
DBS has been used successfully to treat tremors in patients with Parkinson's disease, but for those living with extreme cases of OCD, like Della Grotta, the procedure would be one of the first.
"I remember telling Sheri [that] if I had a 10 percent chance of getting better, that means 1.8 hours of the day I would be relieved from OC symptoms," Della Grotta.
He was willing to do it.
During the seven hour surgery, doctors kept him awake, dropping pennies into his hand to see if DBS could stop his compulsive urge to count.
"With the stimulator on, he didn't and he remembered that, and that's one of his most vivid memories from the surgery," Greenberg said.
A remote device allowed Greenburg to continually monitor the level of electrical charge sent to Della Grotta's brain after surgery.
"You can adjust how strong the stimulation is, how fast it occurs," Greenberg said.
Della Grotta said his condition improved dramatically following his surgery. He said his daily rituals are under control and no longer dominate his life.
"It's like 180 degrees difference," he said. "I'm doing things that I probably never would have done before."
Greenberg said Della Grotta became an active participant in his family, the way he really couldn't do before.
"It's like waking up from a bad dream, that's how much better it is," Della Grotta said. "I felt like I was being reborn all over again."