‘It’s a jungle out there. Disorder and confusion everywhere’People think I’m crazy, ’cause I worry all the time. If you paid attention, you’d be worried too.’
Composer Randy Newman’s theme song from the celebrated TV series ‘Monk’ (USA Network) perfectly characterizes the hilariously compulsive detective. Monk’s list of phobias and obsessions is extensive and debilitating. But, interestingly enough, in several episodes, when he temporarily abandons his obsessive-compulsive nature (for whatever reason), he loses his remarkable ability to solve crimes. Apparently his pathological attention to detail is critical to his talent for cracking even the most convoluted mysteries.
So where does ‘attention to detail’ leave off, and ‘obsessive-compulsive disorder’ (OCD) begin? Is it obsessive to regularly wash your hands so you won’t get sick? Is it obsessive to check your email every hour? Is it compulsive to stand, transfixed, waiting for the toilet tank to fill? Do you worry about the lights or the oven being on—every time you leave home? Let’s face it: All of us have our little tics and fixations. Whether it involves our kids, our personal space or our workplace, we usually feel most comfortable and competent when things are ‘in order.’
The need for tidiness and organization is actually a need for control. This is not necessarily a bad thing. Those of you who read this column regularly know that I equate control with confidence and self-responsibility. Without it, the critical path leading to our goals and our happiness can be laden with wrong turns and unnecessary obstacles.
But, over the years, I have seen many clients whose need for control has become an impediment to carrying out the basic routines of everyday life. Their compulsions and phobias are sometimes so devastating that they cannot even leave the house, much less drive, shop or interact socially.
The Obsessive Compulsive Foundation (www.ocfoundation.org) defines OCD as a ‘neurobiological’ (physical) problem, as opposed to a psychological (mental) one. At the same time, however, they acknowledge that no genetic or other link to physiology has yet been established. Whatever the cause of OCD, all obsessions involve thoughts, images or impulses to do certain things over and over again, and these thoughts and impulses feel out of control. Compulsions are the actions that people with OCD take in order to reduce the anxiety experienced over these unwanted thoughts and impulses. The actions don’t make logical sense—and the person with OCD fully understands this—yet he or she feels compelled to perform the actions anyway.
Having OCD means more than just being a ‘neat freak’ or being very particular about things in general. You don’t have OCD simply because you wash your hands more than average or take extra care to make sure the table is set properly for a dinner party. OCD is a time-eater. People with OCD perform the same rituals over and over again. The behaviors reinforce the obsessive thoughts, and the obsessive thoughts generate more behaviors. It’s a vicious psychological cycle. A person without OCD might check the lock a second time after leaving the house and then say to himself, ‘This is silly!’ Then the anxiety is largely over. A person with OCD, on the other hand, has to check the lock over and over, but the anxiety doesn’t go away. A person with OCD might spend an hour in the bathroom washing and rewashing. Several years ago, I worked with a woman who was admitted to the hospital because she had literally washed the skin off her hands and arms. She knew what she was doing, but she did it anyway.
When the compulsive behaviors created by the anxieties become self-defeating or, in more extreme cases, self-destructive, it’s safe to say the person has OCD. It’s important to understand that there is no cure for OCD, in the sense that you can eradicate the symptoms simply by taking medication or going to therapy. However, therapy is crucial in helping to manage the problem, and with persistence, the intrusive thoughts and impulsive actions can even go into remission for long periods of time. Unfortunately, people who feel they are ‘cured’ will sometimes experience some reawakening of their symptoms during times of severe stress.
At the core, OCD is about anxiety. I see it as worry and anxiety run amok, taking on a special, troubling form. Although research suggests that some antidepressant medications can help by controlling the neurotransmitter known as serotonin, research has also shown that just affecting serotonin is not enough. Behavioral and cognitive strategies, with an understanding and capable psychotherapist, are a critical and necessary part of the solution.
There is a middle ground. We need to be aware of what is happening around us in order to ensure our safety and happiness, but this awareness must be kept in check. Part of life’s excitement and challenge is in taking risks, no matter how small. Without some element of chance, life can become boring and mundane. It’s important to be sure of ourselves so we can adapt and react to whatever life has in store. That being said, we’ll end with the immortal words from Randy Newman’s ‘Monk’ theme, ‘I could be wrong now’but I don’t think so!’