Disorder in its proper place Health: The film 'As Good as It Gets' brings an accurate portrayal of obsessive-compulsion to a public painfully shy of information.

Jack Nicholson's character in the new movie "As Good as It Gets" is a curious man.

Melvin Udall must turn each lock on his apartment door exactly five times. He absolutely will not step on any cracks on the floor or sidewalk. He has to wash his hands in scalding water with a brand-new bar of soap -- then discard that bar immediately.


Melvin Udall is an obsessive-compulsive, and he is bringing the mysterious anxiety disorder to the forefront of public consciousness.

For mental-health professionals and patients coping with OCD, or obsessive-compulsive disorder, this is a very good thing indeed.


"It's important to note that in the movie, [Udall] did seek help," said James Broatch, executive director of the Obsessive-Compulsive Foundation. In reality, "Less than 20 percent of people with OCD are in treatment."

The foundation, based in Milford, Conn., recently conducted a survey of its 10,000 members -- patients, their families and mental-health professionals -- and came to a disturbing conclusion: The average time from onset of symptoms to diagnosis and appropriate treatment of OCD was 17 years. That's because many sufferers are embarrassed by their symptoms, which often include sudden, violent thoughts and an uncontrollable urge to engage in odd behaviors.

They think they're eccentric. Crazy. Alone. Beyond help.

That couldn't be further from the truth. Medications and behavioral therapies enable most patients to understand and ease their mental torture.

And research on the disorder is revealing insight into its causes.

OCD is caused by a biochemical imbalance, according to the foundation. A neurotransmitter, serotonin, carries nerve impulses across brain synapses -- think of your right hand passing information to your left.

A person with OCD does not have enough serotonin to carry the impulse over that synapse. So the impulse ricochets back. When that occurs. the person is bombarded with brain activity that can't be processed in a normal way, prompting odd, frightening thoughts.

The obsessive thoughts fall into common categories. Some new mothers, for instance, are terrified to find themselves thinking about stabbing their baby -- although they would never actually do it and can't understand their thoughts. Other people have violent thoughts about a beloved family pet. Others obsess that a stove burner left on will burn down the house.


To relieve their anxiety over the thoughts, sufferers turn to compulsive behaviors: "If I only kiss my baby five times, these thoughts will go away," or, "If I pet Fluffy then snap my fingers, this will pass," or, "I'll just check the stove one more time." By the time they complete the ritual, the thought has passed. Thus, the person thinks that the ritual relieves the anxiety. But the rituals come to rule their lives.

Marcene Starlin, an Overland Park, Kan., psychotherapist, works with many OCD patients for whom each day is a struggle.

One professional man in the Kansas City area cannot work because his OCD is so disabling.

"He starts out each morning by swinging his legs off the bed three times," Starlin said. "He combs his hair three times. He brushes his teeth three times. His entire day, everything must be done in multiples of three -- even pouring water into the coffeepot three times."

For Ann Gorden of Overland Park, the seemingly mundane task of emptying the trash was actually a nightmarish ritual that left her contemplating suicide.

"I thought there was something very odd wrong with me, but I didn't know what to call it," said Gorden, a 52-year-old housewife.


Gorden thought the items she disposed of would "incriminate" her in some way. She had to meticulously examine everything that went into the garbage.

"I spent many, many hours going through the trash; I would be up very late at night," she said. "It was very difficult." She hid her behavior from her husband and two children. Then late one night, 13 years into her marriage, her husband found her. "I felt like a nut case," she said. "I had paper towels in my hand -- I had to shake them to make sure there was nothing in them to put them in the trash bag."

Her husband was puzzled and confused. Gorden was relieved. "I was so tired by that point I wasn't going to lie -- and how could you lie your way out of that, anyway?"

Gorden found help through drug therapy and behavior modification techniques. Now she wants people to know that sufferers "don't choose to have this; they don't do this for attention or pity. It is so miserable to live this way."

Diane Snow, 43, has coped with OCD since childhood. A longtime health-care worker in Los Angeles, Snow founded the OC Foundation of California three years ago to help others.

She also helped director James L. Brooks present OCD to movie audiences in a realistic manner in "As Good as It Gets."


In May 1996, Brooks sent a copy of the script to Snow, two other patients and two mental-health professionals for critique. "Jim told us that this was not a documentary on OCD, but he wanted to make sure he was very accurate about the information that was coming across," Snow said.

So she read the story of Melvin Udall, a novelist who lives his life at war with himself and the world. In one scene Udall hurls anti-Semitic insults to oust a Jewish couple from "his" table at a restaurant; in another he sneers horrible anti-gay slurs at a neighbor. Udall is a mean, angry, frightened man, who eats only with plastic utensils and uses gloves to touch anything outside his apartment.

Snow sent to Brooks four pages of what she called "adjustments."

Snow's group mainly was worried about the opening of the film, in which Udall angrily deposits his neighbor's small dog down a trash chute. "The concern was that people would walk away thinking that people with OCD were violent. That couldn't be further from the truth," Snow said.

That scene stayed -- Brooks "pointed out it was an entertainment piece," Snow said -- but the group did help the director otherwise fine-tune the movie and was pleased with the outcome.

Snow has been to three screenings and has noticed how audiences react to Melvin's OCD.


"They thought it was eccentric behavior in the beginning. Then they heard snippets that there are medications, there are behavioral therapies, there is a real explanation for this," Snow said.

"They became a little more understanding. That was a key, for me at least, watching to see how the audience reacted."

Symptoms of OCD

Obsessive-compulsive disorder, or OCD, can wreak havoc with a person's life. It is a biochemically triggered, anxiety-based mental illness that sparks intrusive, often violent thoughts that prompt compulsive activities.

Most sufferers, about 80 percent, experience both obsessive and compulsive symptoms. Here are some typical symptoms and behaviors, adapted from the OC Foundation of California.

A person with OCD may:


Check objects repeatedly, such as doors, locks or stoves.

Constantly count, either in his mind or outwardly.

Feel the need to "have" to do an activity, such as wash one's foot exactly four times during each shower.

Arrange items in a very orderly manner that makes sense to him but no one else.

Experience images "popping" into her head, usually of a disturbing nature.

Endure nonsensical words or phrases repeating in his mind.


Hoard objects with no apparent value under a rationalization such as, "But what if I need small pieces of lint some day?"

Worry excessively about germs and have an overwhelming fear of contamination.

The facts

An overview of obsessive- compulsive disorder, or OCD, from the National Institute of Mental Health in Bethesda.

Number of sufferers: While OCD was once considered to be fairly rare, research in the late 1980s showed that it affected more than 2 percent of the population, making it more common than schizophrenia or panic disorders.

Sex: Both sexes are affected in about equal numbers.


Age symptoms appear: Typically early adolescence, but recent research shows that children as young as preschool are affected.

Related problems: May be accompanied by depression, eating disorders, attention- deficit disorder, Tourette's syndrome or trichotillomania (the urge to pull out hair).

Recent scientific findings: Magnetic resonance imaging studies conducted in 1996 showed definite brain abnormalities in OCD patients. A 1997 study also pointed to a genetic component.

Research: Gerald Nestadt, associate professor in the department of psychiatry at Johns Hopkins Hospital, is studying whether OCD runs in families. The study began three years ago and has 100 participants to date.

Treatment: Anti-anxiety medications and antidepressants are often helpful, as are relaxation techniques and behavior modification work.

Organizations: Information on OCD can be obtained from the Obsessive-Compulsive Foundation, P.O. Box 70, Milford, Conn. 06460; 203-878-5669.


Pub Date: 1/13/98