Tony Shalhoub as Obsessive-Compulsive detective Monk (2002-2009, USA Network)
Dr. Paul Cefalu, professor of English at Lafayette University is working on an interesting book titled Wringing Our Hands: Obsessive-Compulsive Disorder and the Morality of Will. The book is an extension of Dr. Cefalu's scholarly research interest: Obsessive-Compulsive Disorder (OCD) in the media. Professor Cefalu's collection of essays promises to cover a number of interesting issues, including:
"Why do the mainstream media nearly always represent OCD as humorous? Is there something particular about the contemporary culture of irony that shapes recent pop cultural depictions of the disorder? Why has there been a proliferation of interest in compulsive hoarding, a common subtype of OCD? How should compulsive hoarding be distinguished from avid collecting? Why has much of the recent self-help work on OCD focused on scrupulosity (pathological guilt about moral or religious issues)?" (Dr. Paul Cefalu, Lafayette.edu).
As someone who has lived most, if not all of their life with undiagnosed obsessive-compulsive disorder, I have not given this topic much thought until very recently. While I look forward to reading Dr. Cefalu's book, I am not going to wait to delve into this issue myself. He does raise a good question: Why is OCD so funny?
According to the National Institute of Mental Health (NIMH), Obsessive-Compulsive Disorder is no laughing matter. The NIMH estimates that "OCD affects about 2.2 million American adults, and the problem can be accompanied by eating disorders, other anxiety disorders, or depression" (NIMH). Dr. Cefalu writes that "once characterized as a rare psychiatric disorder, obsessive-compulsive disorder (OCD) affects more than one in forty individuals, or approximately five million Americans" (PMLA, 2009). OCD is not a "stand alone" mental illness, in that most people who are diagnosed with OCD are usually diagnosed with another mental illness as well, such as generalized anxiety, post-traumatic stress disorder (PTSD) or depression. OCD can also be linked to eating disorders. OCD is very treatable with medication and/or cognitive behavioral or exposure therapy. Left untreated, OCD can become debilitating to the individual to the point that they may become unable to function because of their rituals and chronic worrying. In 2009, the FDA approved deep brain stimulation for severe cases of OCD. According to a recent NPR report, so far 50 such cases have been treated by implanting an electrode deep into the tissue of the persons brain which helps to disrupt the train of obsessive thought. According to the report which recently aired on All Things Considered, "stimulation helps about half the people who get it, probably because it's altering brain circuits involved in mood and behavior" (NPR). Deep brain stimulation has proven to be an effective treatment in some cases of Parkinson's Disease and there is hope that it will also help people who suffer from OCD or might at least lead to more research as to the causes and conditions of obsessive thought and anxiety disorders.
I hope that I have fully laid the groundwork for an argument that Obsessive-Compulsive Disorder is fairly common and somewhat misunderstood. This leaves the question still, what is so funny about that? "mainstream depictions tend to make us forget that, according to the DSM IV, OCD is fundamentally an anxiety disorder, hardly a laughing matter to most of its long-term victims" (Cefalu, 2009). According to Dr. Cefaflu, OCD has been around since Biblical times and has had many and varied appearances in literature and pop culture, as both a vehicle for comedy as well as tragedy. "In the earlier historical incarnations of OCD as scrupulosity, monomania, or the doubting disease, the condition more often showed up in melodramas, tragedies, and Gothic literature—in texts by Flaubert, Baudelaire, and others, especially Edgar Allan Poe, whose protagonists are frequently beset by an idée fixe or monomaniacal passion" (Cefalu, 2009).
Dr. Cefalu rightly points to some very successful movies such as Jack Nicholson in As Good As It Gets, Will Ferrell in Stranger Than Fiction who must overcome their OCD tendencies in order to fully experience life.
But Dr. Cefalu notes that the most recent incarnations of OCD have come in the form of stories, where characters exhibit the symptoms of OCD as a part of the comedic humor of the story. Other movies, such as Matchstick Men with Nicholas Cage and the television series Monk focus on characters with serious OCD symptoms who make extra work for themselves in order to deal with minute changes in their environment.
While the rituals and constant "hand wringing" make for a terrific visual gag for comedy, it does little to actually educate as to what the internal life of the protagonist is actually like. The one movie that stands out in sharp contrast with the "OCD as a gag" motif is The Aviator with Leonardo DiCapprio. Based on the true-story of the life of genius aviation pioneer Howard Hughes, The Aviator, I believe shows the devastating side of OCD in the life of an otherwise very functional, sophisticated and successful man. By the end of Hughes life, he was a complete recluse, unable to communicate with his colleagues and associates, collecting jars of urine in his closet and ceasing bathing or cutting his hair. He died a very sad and lonely death, and there is nothing funny about that.
I do not want to come across as completely humorless or a wet blanket. I do think that some of those roles portrayed by the actors were quite funny and amusing, but simply focusing on the ritual behavior of OCD is like focusing on hallucinations in schizophrenia - it is an incomplete statement.
Intrusive thoughts are the hallmark of OCD behavior, and without understanding them you cannot appreciate the mental disorder. According to the NIMH "obsessive-compulsive disorder (OCD) is characterized by intrusive thoughts that produce anxiety (obsessions), repetitive behaviors that are engaged in to reduce anxiety (compulsions), or a combination of both" (NIMH). These intrusive thoughts can range from the benign to the severe and can run the gambit of horrifying and irrational fears. Not unlike unfriendly and threatening auditory hallucinations, in OCD, your brain chooses the worst possible fears that you have and projects them over and over again without cause or warning. The rituals, the behavioral symptoms of OCD are self-soothing in that they are an attempt to mitigate the intrusive thoughts.
The good news is that aside from psychiatric medications and psychological counseling, there are a number of blogs and web sites which specialize in sharing personal experiences about mental health issues and best practices. The Experience Project is one of the better blogs that I found concerning OCD and problems of intrusive thoughts.
The media has a long way to come in fully appreciating OCD in its full spectrum of behavior, both comedic and tragic. While it is important that we learn to laugh at ourselves, we must not lose sight of the fact that it might be funny but it's not that funny.