ObsessiveCompulsive Disorder

– “As Good As It Gets” Essay, Research Paper

Obsessive-Compulsive Behavior: ?As Good As It Gets?

?Melvin Udall is the most dysfunctional of men, an acid tongued romance novelist who suffers from obsessive-compulsive disorder. Never one to avoid confrontations, he takes pride in his ability to affront, repulse, offend and wound – as he has been. His targets are random; his aim reckless. Leave an elevator in which he stands; cross a street on which he walks. He is to be avoided at all costs, but some victims just cannot escape. Carol Connelly is the only waitress at the local caf? that is willing to stand up to the sarcastic tirades of Melvin. Simon Nye has the distinct misfortune of living across the hall from Melvin in their West Village apartment building in downtown Manhattan. These three New Yorkers – non of whom appears to have a chance in Hell of finding real happiness – discover their fates intertwined because of the fourth complicated character in the piece, an ugly, tiny dog named Verdell.?

This is the description you can find on almost any website dedicated to the film ?As Good As It Gets?, and it is a good description of what you see when you view the movie. However, we shall take a closer look at one particular aspect – obsessive compulsive disorder. Anxiety about thoughts or rituals over which you feel you have little control is typical of Obsessive-Compulsive Disorder (OCD). OCD can take so many different forms. Let’s try to make sense of it. Obsessions are thoughts, often intrusive and upsetting. Obsessions are to be distinguished from ruminations or worries about routine life issues such as finances, children or job security. Some examples of obsessions in OCD may be thoughts or mental images of an upsetting nature like violence, vulgarities, harm to self or harm to others. Obsessions may be of special numbers, colors, or single words or phrases . . . sometimes even melodies. Examples of what kind of things a person can be obsessed with are; germs, dirt, doubt, order, symmetry, repugnant sexual thoughts, repugnant religious thoughts, repugnant images, horrific images, violent images, the fear of forgetting, and the fear that a mistake will harm a loved one. People with OCD show a range of insight into the senselessness of their obsessions, and often especially when they are not actually having an obsession, they can recognize that their obsessions and compulsions are unrealistic. At other times they may be unsure about their fears or even believe strongly in their validity. Most people with OCD struggle to banish their unwanted, obsessive thoughts and to prevent themselves from engaging in compulsive behaviors. Many are able to keep their obsessive-compulsive symptoms under control during the hours when they are at work or attending school. But over the months or years, resistance may weaken, and when this happens, OCD may become so severe that time-consuming rituals take over the sufferers’ lives, making it impossible for them to continue activities outside the home.

Could you imagine to constantly be thinking over and over about something, such as keeping your hands clean from germs? Now imagine yourself washing your hands repeatedly for an obscene amount of time because you want relief from these nagging thoughts. At the same time you realize, “Gosh, what am I doing?” These are the symptoms of an individual with Obsessive-Compulsive Disorder. OCD is an anxiety disorder which carries a person’s ordinary concerns to an extreme. The disorder is characterized by a series of obsessions, which are reoccurring thoughts, or fears, that constantly persist throughout a single day and which inevitably drives an individual crazy. Compulsions are actions, or thoughts, that the individual performs to briefly relieve their obsessions. Two other characteristics of OCB are the recognition of these symptoms as being unreasonable and the consumption of time due to the routines.

A compulsion is a repetitive behavior in response to an urge. It is difficult to stop this behavior. Obsessions provoke compulsions. Examples include washing the hands too many times, showering too frequently or washing things about the home like clothes or floors or even groceries. How much is too much? Many experts agree that engaging in more than an hour a day raises suspicions of OCD. Compulsions are often performed repetitively and in some stereotyped or ritualistic fashion. You may be bothered by urges to perform rituals like repeatedly turning off and on a light switch until it ‘feels right’.

Some of the compulsions (doing it repeatedly) a person with OCD might have are among others: washing hands, shower, check locks, check stoves, touch things, count items, order things, clean things, and perform silly rituals until it ?feels? right.

We can see some of these examples in the film; when Melvin turns on/off the light switches five times every time he wants to turn on or off the light; when he always washes his hands with two bars of soap ; when he brings his own plastic eating utensils to the local caf?; he always has to sit at the same table at the caf? – and even scares away people that are in his spot when he arrives (it upsets his routine).

Often the obsession comes first and the compulsion seems to be a response to the obsession. For example, a person may have an obsessive fear of ingesting or absorbing illegal drugs from indirect contact with people they suspect to be taking illegal drugs. Such a person may obsessively fear losing his mind from using a restaurant’s public rest room after seeing someone they suspect may be a drug addict using the facility. After leaving the restaurant, he may have to throw away his shoes and floor mats in his car that may have been ‘contaminated’. He may have to scrub his hands in bleach exactly ten times perfectly. Other articles of clothing may have to be washed repeatedly or thrown away. He may be afraid to take medicine that has been touched by a pharmacist who he thinks might be using marijuana after hours, fearing that some of the residue might have contaminated their medicine. There is no pleasure in carrying out these rituals. There is only temporary relief from the anxiety caused by the obsession.

Up until a few years there were no effective treatments for OCD, but new medications and behavior therapy now give many patients significant relief. In behavior therapy, the patient faces squarely the OCD difficulties either in a gradual step-by-step manner or in an aggressive one-step way. The technical name for this process is exposure and response prevention. Experts believe that behavior therapy is an effective treatment used by itself in certain patients with OCD if done well and vigorously. Certain other patients will only respond to medication. Many patients find the combined use of medication and behavior therapy most effective.

In Melvin?s case the therapy is Carol, because you see him getting better and better the more time he spends with her – she is his cure. Melvin also takes medication, but Carol is the best remedy for this OCD patient. Some patients actually need nothing more than the medication and they make a full recovery and need no further treatment. Other OCD patients would definitely benefit from behavioral treatment called exposure and response prevention, and this is exactly what happens to Melvin – Carol is his behavioral treatment.

I have included some interesting facts about OCD below:

Although adults realize in part that these obsessions and compulsions are senseless, they have great difficulty stopping them. Children with OCD may not realize their behavior is unusual. There is a link between serotonin and dopamine, brain neurotransmitter chemicals, and OCD. Often OCD affects the family. Family members are sometimes drawn into the OCD behavior. Disability may affect family finances. Medication for OCD should be tried 10-12 weeks before judging effectiveness. OCD affects men and women equally. OCD can start at any age. In one third of adult patients the symptoms begin in childhood, adolescence or young adulthood. OCD afflicts approximately 2% of the population. The untreated symptoms may vary for years. The symptoms may go away, remain the same or worsen.

Evidence suggests that OCD runs in some families and may be genetically inherited. It is not uncommon for a person with OCD to also have clinical depression, panic attacks, or both. Persons having OCD often cleverly hide their OCD successfully from family and friends and coworkers. Few OCD patients respond to placebos in contrast to 30 ?p; 40% of depressed patients. Persons having OCD often exhibit abnormal rates of metabolic activity in the frontal lobe and the basal ganglia of the brain.

One can see some of these in Melvin, as well as in his surroundings and the people he associates with. Some people may think that this disorder seems funny, or even ridiculous, but the fact is that it is a very serious matter for people like Melvin, and the people who surround him, like Carol and Simon. I do not think many people would turn the other way if someone threw their pet down a trash shoot, and OCD can take a person to extremes that they are really not completely aware of. It is something that needs to be recognized as an actual medical disorder, and not just be looked upon as some person just being overly eccentric.

In looking at the treatments available for OCB patients, I consider Cognitive-Behavioral Therapy (CBT) as the most effective treatment. Although serotonin reuptake inhibitors (SRI’s) have proven to be successful, I am fascinated by the notion that there is an “I” function which is at work when a patient undergoes CBT. In considering the “I” function, it acts as a synthesizer of all the information made available, and then it decides what to do. The “I” function stems from the rational side and takes place of the irrational side. In this manner, the “I” function acts as the instinctive response and decisive response. SRI’s inhibit the uptake of serotonin back into the pre-synaptic neuron by “clogging” up the passages. In this manner, there is an increased amount of serotonin in the synaptic cleft between the pre-synaptic and post-synaptic neurons, and every once in a while, serotonin will be absorbed by the post-synaptic neuron. Examples of SRI’s are clomipramine (anafranil), fluoxetine (prozac), fluvoxamine (luvox), paroxetine (paxil), citalopram (celexa), and sertraline (zoloft). From personal experience, I would have to say that I wonder how these medications actually work, because I have taken both Paxil and Celexa (depression) without noticing any major improvement at all over time.

Cognitive-Behavioral Therapy (CBT) is a conceptual process in which the individual must have faith in his own rationalization skills. Rational refers to an individual’s reasoning ability, and irrational relates to an automatic instinctive response to certain events. An example of an irrational response would be the belief that by touching a door knob one may contract AIDS. The rational side would point out that it is impossible to simply touch a door knob and get AIDS. In this case, CBT deals directly with the individual’s choice in response to the obsession: “should I, or should I not touch the door knob.” In examining the basis behind the therapy and disorder, the obsessions stem from the irrational, or primitive, part of the brain and not from the forebrain which is the rational portion. As the primitive part of the brain is misfiring biologically, the reasonable neo-cortex is confused by the false alarms. Thus, it is conceivable that the individual may realize that what he is doing is an unreasonable mannerism. The principle behind CBT is to help the patient decipher what is rational and what is irrational. The consequence would be to substitute the irrational form of thinking with the rational form.

In considering a person suffering from OCB who loves to collect things, commonly labeled as a hoarder, a possible therapy would be to encourage the patient to first encounter his compulsion to collect so many items. In the treatment, two possible components are to analyze how many times a day the patient collect items, and how much he collects. The therapy could consist of helping the patient face his fear and to talk through it, then reduce the amount of times during the day that he is allowed to keep items and also the amount of things he may hold on to. This would go on for a few weeks, in which case as the patient progresses, the limits would be reduced. Other factors which may influence the patient would be to insist that the patient accepts the risk of losing an item, and to fight the anxiety to keep the item regardless of the discomfort level. The more pain one is willing to endure the less it is experienced.

Although there is no cure for OCD, there are several treatments to help lessen the effects of OCB. The individuals who do use CBT as a form of therapy recognize a 50-80% decrease in the symptoms, and of the individuals who use SRI’s, 70-80% respond to the effects. However, once the individual stops using SRI, the symptoms take over again. The best solution is to use both forms of treatment, or to use the SRI’s as a quick start process, but then revert to using CBT as a later form of treatment. CBT is a fascinating treatment, because it allows humans to use the forebrain, which is the most highly developed portion of the brain. CBT is a conceptualizing exercise which pushes the OCB patient to understand both their irrational and rational sides. The process is extremely hard to swallow for the irrational side is automatic and involuntary, urging the patients to react to an event at will. However, if the person (Melvin) suffering from OCB practices this therapy extensively, though he may not be cured, life will become a lot easier. I believe that this is definitely the case with Melvin, since he gets better while on his medication and at the same time getting ?therapy? from Carol, the more time they spend together. Simon, Carol, Verdell, and all the other people that Melvin associates with on one level or another, is unconsciously helping Melvin improve over time.

?Monitor on Psychology?. American Psychological Association.

The American Psychological Association.

Obsessive Compulsive Disorder Foundation.

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