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Just Like Starting Over (And Over, And Over) 

With Obsessive/ Compulsive Disorder, the devil is in the details

By the time I finish writing this introduction, it will be time for me to pack up and go home. Well, not exactly. It will be time to start getting ready to go home, which, depending on the day and my mood, might make for a quick exit or, more often than not, make me late for dinner.

Before I leave, I'll check the text I've penned for misspellings, grammatical errors, and superfluous words. The Microsoft Word file I'm writing this in will be closed. . .and then reopened, to make sure it saved correctly, then closed again, then opened one last time, just to be sure. I will finally "X-out" of the program, and then check my e-mail one (or five) last times to make sure I haven't missed anything important. I'll gather my things -- CDs, books, sheets of paper with jotted scribblings -- and place them aside. I'll shut down my computer, and check my phone messages. I'll turn off my monitor, checking to be sure the little green light is no longer blinking. I'll walk to the printer to confirm that I haven't printed out something and absentmindedly left it stranded. I will then walk back to my PC, re-check that it's turned off, go back to the printer, check the fax, and return for one last go-round at the desk. Blinking light "off," phone not blinking, everything present and accounted for. Yes, now it's time to go home, time to enjoy the spoils that a career in the lucrative field of journalism has afforded me. After, you know, checking my desk one more time just to be sure.

Obsessive-Compulsive Disorder, commonly known as "OCD," affects anywhere from two to three percent of the world's population according to the Journal of the American Academy of Child and Adolescent Psychiatry. Typically, the age of onset for OCD is late adolescence or early adulthood. Recently it's been described in the media as "mental hiccups," which probably gets close to the crux of the disease. With OCD, a person's brain latches on to something -- say, making sure the stove has been turned off -- and can't let go until completely satisfied. That's the "obsessive" part of OCD. The "satisfaction" part comes from the "compulsive" part of the disorder -- washing your hands, counting things, the excessive arranging and re-arranging of things, counting the number of syllables in whatever you're reading, and so on (and on, and on).A person may have one or two of these so-called "hiccups" and still live a perfectly "normal" life. In fact, many people have a few symptoms of OCD, a few specific obsessions they deal with on a day-to-day basis. It's only when the symptoms persist, make no sense to the person having them, or cause distress, that treatment may be necessary.

OCD is starting to get the kind of media attention lavished a decade ago on Tourette Syndrome. Nonetheless, it's still a very misunderstood affliction, even as it becomes more and more common in our increasingly info-driven, packed-schedule society (stress is a major trigger of OCD). The "hook," of course, is the compulsive behavior, which makes for good copy in much the same way as the uncontrollable swearing that sometimes comes with Tourette Syndrome did.

Enter sonorous, TV-style voiceover: "But OCD is no laughing matter, especially to those who have it." Which is true. Like any anxiety-based illness, it often leads to feelings of shame from the afflicted persons. While it might be cute or kooky or off-kilter or "weird" to drive around the block three times before arriving home -- or, say, to check the damn stove another 50 times -- the person experiencing the compulsion also usually feels another emotion: repulsion.

In the last five years or so, many different representations of obsessive/compulsive behavior have made their way into popular culture. There's the Emmy-award winning Monk, a show featuring finicky detective Adrian Monk (Tony Shalhoub). In the realm of film, there's As Good As It Gets starring Jack Nicholson as cranky OCD sufferer Melvin Udall. Mostly Martha, starring Martina Gedeck, is the story of an obsessive-compulsive chef at a chic restaurant in Hamburg, Germany. There's also Matchstick Men, with Nicolas Cage as an OCD-impaired con man. The specifics of OCD weren't all that important to Matchstick Men director Ridley Scott, according to the Centre Daily Times: "The disease itself doesn't interest me," Scott said. "What interests me is how it affects his ability to deal with other people."

The trouble is that when the fundamental premises behind a disease are ignored, those shows, books, and movies' credibility falls apart. For instance, it's extremely unlikely that anyone with OCD could function successfully as a detective (Monk) or a con man (Matchstick Men), since both sides of the crime coin involve reacting to unique and strange surroundings almost daily.

But this month sees the release of the most anticipated OCD-themed representation of all time -- as well as the most medically accurate -- The Aviator, starring Leonardo DiCaprio as pilot and magnate Howard Hughes.

Dr. Jeffrey Schwartz, Research Professor of Psychiatry at the UCLA School of Medicine, has authored three popular books with HarperCollins, Brain Lock: Free Yourself From Obsessive-Compulsive Behavior (still considered the seminal text on OCD), The Mind and the Brain: Neuroplasticity and the Power of Mental Force, and Dear Patrick: Letters to a Young Man. Schwartz was recently hired by director Martin Scorsese as an OCD consultant for The Aviator, in hopes of portraying Hughes' legendary case of OCD in the most realistic light possible.

"In Europe, I hear more stories about them presenting (OCD) in a way where it's less than sympathetic -- where the people are treated as freaks, basically," says Schwartz.

"This film is an extremely good portrayal of what an unchecked case of OCD can be like. Howard Hughes' life was completely devastated by OCD, so you're probably going to see for the first time what it's really like. They gave me a lot of time and access. I went over the entire script line for line with Martin Scorsese and Leonardo DiCaprio, and Leonardo and I spent a lot of time together over several months getting the details of OCD accurately. In no way can I claim I'm unbiased, but I think it's as good a portrayal of mental illness as has ever been done in cinema."

Book publishers have begun to see the comedic and narrative possibilities of portraying the OCD experience, too. Motherless Brooklyn, a novel by award-winning author Jonathan Lethem, is a mystery novel featuring a detective with Tourette Syndrome and accompanying OCD. Steve Martin's The Pleasure of My Company is a lighthearted novella about Daniel Pecan Cambridge, "a savant whose closely proscribed world is bounded on every side by neuroses and obsessions."

Jennifer Traig, an author and contributor to magazines like McSweeney's and others, recently penned what may be the first OCD memoir. Entitled Devil in the Details, it's a look at Traig's lifelong battle with OCD, as well as a memoir of growing up with a disorder few people had taken the time to understand.

"My case was crippling for a year or two," says Traig. "I know people where it's ruined their lives. But I guess since I'm somewhat over it, I do find it funny. I don't object to them (the media) using it as comic fodder. But the one thing I do object to is this -- someone like Monk doesn't have just one compulsion. He has every compulsion. You either count or you tap -- you don't have both. But I do think (the coverage) sort of defangs the whole thing and makes it a little less scary."

Traig's particular battle was with a substrata of OCD called "scrupulosity": in essence, a religious-based compulsion that might well be the most powerful form of the disease, as well as the most common. Didn't check the door lock 10 times? No biggie -- the worst that can happen is a few things get stolen. Maybe you have to cancel your credit cards and change your locks.

Screw up with your scrupulosity, and people could die.

Having grown up in a Catholic family, scrupulosity (the religious take on OCD) was a natural for me. My brother and I used to hold "pretend Mass," with him reading from a children's Bible and serving a Eucharistic snack of cherry Kool-Aid and saltine crackers. I never missed a Sunday. Real-life confession to a priest was particularly engaging. I'd go in, maybe mention that I'd lied to my parents or lusted after another kid's gal. I'd sit quietly, and then wait for my resolution. "What's that? Say 100 "Hail Marys'? No problem!" (Sometimes I'd go over by a few, just to be sure.)

Going to sleep at night, I'd include all my family members and friends in prayers -- as well as their pets -- all by name. If I ever felt a lapse in concentration while reciting this laundry list, I'd start over from scratch. When finished, I would say the sign of the cross -- Father, Son, Holy Spirit -- while trying to visualize each particular component (which is, of course, impossible, but it didn't stop me from trying). I would then do a series of small crosses on my forehead, lips, and chest, of the type seen during Eucharistic preparation. At first, I'd do seven of these, as seven was said to be "God's number." Later on, I decided I might be better off squaring the whole thing, which led me to doing 49 series of forehead / lip / chest touches. (That's 147 total crosses, for you "counters" out there. You know who you are.) By this time, I was usually too tired to care, and would doze off. Some aren't so lucky.

"It was some years later that I realized what my (OCD) was -- I was watching Oprah," says Traig. "I knew I'd been crazy, but I didn't know the name of the disorder. It was such a specific form of OCD -- Religion! Religion! Religion! -- but it wasn't until I started my book that I knew that it was called "scrupulosity.' "When I found these stories, I was convinced I was looking in a mirror. I thought I was the only one, and then I found that it wasn't at all unusual."

Traig is of the opinion that religions big on symbolism and ritual -- Islam, Judaism, Catholicism -- are more likely to incubate OCD sufferers than other, more reflective ones.

"I've never heard of a scrupulous Buddhist," Traig says. "The more you have to do, the easier it is to fall into. It became apparent early on that this priest I know was scrupulous. He would get into such a lather over the crumbs of the communion host, and would spend an inordinate amount of time "raking down' the host, afraid he was wasting a crumb of it.

"I'm still not perfect," she continues. "I check a little, and I have my little quirks. (But) as long as it's less than 30 minutes a day, I'm not going to go on medication. That's my rule. But once you know what it is, it's easier to detach yourself -- "That's the third time I've searched for my wallet, and it's right here. That's OC. Now stop it!'"

How do you get relief from the effects of OCD? At this point, two things have been shown to help sufferers of the disease: self-awareness of the compulsions, whether through therapy or meditation, and something called serotonin reuptake inhibitors (SRIs). According to the Journal of the American Academy of Child and Adolescent Psychiatry, "SRIs are the only medications superior to placebo in the treatment of OCD." Interestingly, Jack Nicholson's character in As Good As It Gets is the only character in pop culture who has used a drug-related treatment. When he says near the end of the film that "50 or 60 percent" of OCD sufferers respond to drugs, he's not just whistling Dixie (over and over).

Experts aren't sure where the disease comes from, but current research seems to suggest that molecular causes could be a factor, with one study suggesting that OCD could be triggered by strep infections.

"It's a medical disease, not a psychological disease," explained Dr. Suck Won Kim, associate professor of psychiatry at the University of Minnesota, to the St. Paul Pioneer Press. "Most people will never understand OCD and how serious it is. It's so foreign to people. Experts all agree that there is no evidence of a major psychological contribution to this disease.

"There is evidence that untreated OCD gets worse," Kim continues. "Some of these people become reclusive, like Howard Hughes, who had the worst case of OCD ever known. Can you imagine the torture they have to go through living their whole lives and having to, for instance, walk five steps backward every time they walk seven steps forward? These rituals are torture for them. With treatment, they function very well. Untreated, they are miserable all of their lives."

Dr. Schwartz of UCLA suggests that drug treatments aren't innately any more effective than a "pull up your bootstraps" mental approach that focuses on what he calls "The Four R's": Re-label, Reattribute, Refocus, and Revalue. Schwartz also says that catching the disease early in life is a key to changing compulsive behaviors.

"I keep developing the psychological model -- so in that way, the treatments are improving. The way to do cognitive behavioral therapy is in some ways improving -- unlike the drug research, in many ways -- because our concept of mindfulness is becoming more readily explainable, and the relationship between mindfulness and biology is getting much clearer. I think this is making mindfulness more accessible, and so in that way I'd say the treatment is improving. I don't think it's improving in any way that involves drug treatment.

"I haven't heard about it in the last couple of months," he continues, "but for the last year or two, I was really worried that they were going to do brain implanting with electrodes for people with OCD. They would do it if they could get away with it. I'd like to create a public awareness that that's not a good thing. There is just no big change in drug treatment. The drug treatment is the same as it always was. SRIs are still the main pharmacological treatment by far, but they're limited for a lot of people. There's been some slow progress with using brain surgery, making small lesions in the brain for people with OCD. The people who push these things, especially the brain implants, have their own agenda. It involves drilling a hole in the skull. It's very serious business. But they don't treat it as seriously as one would think."

Others find brainstorming a more palatable alternative. "I'm what's known in the parlance of support groups as a facilitator," says Cecil King, head of a Charlotte-based OCD support group. "We formed back in 1991. We've had several names for the group; right now we're calling it "It's Over!' Some nights we don't have very many people, and sometimes we get a good turnout. We're on the internet, and we're on SupportWorks, which is a clearance house of self-help groups in Charlotte.

"(In talking to a doctor), he told me that he didn't think that I had OCD, but that I had anxiety issues," King says. "When I told him that I was most worried about going crazy, he told me that a person usually doesn't go crazy after 35 unless they already were before. And so when I would share that with people, they seemed reassured. When you have OCD, you feel like you might lose your mind. I wanted to get the word out that OCD does not cause you to go crazy. It can cause you lots of anxiety, and you can be unsure of yourself, but it does not cause you to go crazy. And that's the reason we formed this group.

"Basically, people talk about their life in the meetings, or maybe what life has been like for them, and what it's like now," King continues. "So many people talk about what life was like before they had a diagnosis. So many people are pleased that they did get a diagnosis, and other people have it, and here they are! That's when the group works best -- when we have people who can identify with what the other person's problems are."

King, interestingly, is a proponent of drug treatment, albeit "blended" with a combination of faith and fellowship.

"The purpose of the medicine is to help people understand better what they're supposed to do," says King. "The thoughts stay in their head better. They're able to believe that what they're doing in terms of therapy is really going to help them. If your brain is unable to absorb what's being taught, it just goes right past you. What you're learning in the way of therapy just sticks with you better with the drugs. I know that's an oversimplification, but it's true. You stand a better chance of beating this if you have a month or six weeks of medicine behind you."

"I've been fortunate enough to meet more people with OCD since I wrote Devil in the Details," says Jennifer Traig. "I can't understand them at all! They seem so weird to me! Mine I understand. Like, why would you be afraid of your keys? They're just keys! Doorknobs? I totally get you."No doubt, OCD is an interesting disease, apparently even to other OCD sufferers. Few conditions have such an array of unique personality-centric symptoms -- which, again, makes it great grist for the media mill. However, that same quality too often leads many to feel they're alone in the world, even among other OCD sufferers.

"I couldn't believe that anyone else in the world had this," says Traig. "Had I known that "You're not so special,' and that there's these miracle drugs, it would have been much easier to take. If I could say something to anyone reading this who finds that the descriptions sound a little too familiar, it would be that you just have to bootstrap it along to your doctor and you can really make some inroads.

"After I got better, I was angry about it for a little bit," she continues. "This was a disease, and I couldn't help it. It wasn't just acting up. I think (my family) did me a favor by insisting that I could help it. Which, in the long run, probably did help it. I gained a certain mastery over my compulsions."

Which, ultimately, is perhaps the only real way to fight OCD, whether with the use of drugs or without.

I was able to overcome my OCD-like symptoms with a little thought and (non-repetitive) prayer after realizing that the Catholic Church wasn't for me and that the Creator probably didn't give two shakes one way or another if I repeated something two times or 200. For others, a combination of drugs and mindful thinking seems to work well, with the drugs taking the sharper edges off the disease and making compulsions seem somewhat more manageable. Others still disdain treatment altogether, and get Martin Scorsese movies made about their suffering.

Suffering for one's art is one thing. Suffering for someone else's art -- while all too common in today's affliction-of-the-month cultural environment -- ought never be an issue.

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