Fran Sydney was 5 when she first began to heed the irresistible urgings that came from what scientists call the primitive part of her brain. ”I would stack toys when I was a child instead of playing with them, because then they weren`t scattered and apart,” Sydney recalls. ”It`s almost like a part of you is being scattered. Everything that is your responsibility or that you own becomes an extension of yourself, and if it`s out of place, then you are.”
At age 15, Sydney`s grandfather died, and she herself was in an accident in which a childhood friend was killed. Triggered by those stressful events, her thoughts became more tortured. ”The only way I could control my fear of death or having things happen that shouldn`t happen was to make sure that everything was neat, orderly and symmetrical,” she says.
Sydney`s compulsions then began to take over her life in her early 20s, when she got married, and they continued to dominate her after she had children. ”I had an apartment, and it was my responsibility. I thought that if everything was perfect in it and orderly and neat and clean, then nothing bad would happen to my family. I knew that wiping the stove that had been cleaned to perfection was not important. With my intellect, I knew it was more important to go to my daughter`s play at school than to clean something that had already been cleaned. But I couldn`t stop. It had to be done or I felt that I was going to explode inside.”
Sydney suffers from what psychologists and psychiatrists call obsessive-compulsive disorder. Once thought to be a rare problem, obsessive-
compulsive behavior has been found to be surprisingly common, about 50 times more prevalent than previously estimated. One out of every 40 Americans, according to recent surveys, will be affected by this disorder sometime in their lives. This means that at any given time, more than 3 million people in this country are tormented either by intrusive, unwanted thoughts and impulses or by a drive to perform such ritualistic actions as handwashing. Sometimes they are plagued by both symptoms, and they are powerless to stop either one. Most people don`t understand such compulsions. These are not the same as the urges felt by perfectionists to seek flawless results, or by superstitious people to wear specific articles of clothing to bring about good luck. Obsessive-compulsives suffer unremitting anxiety, the kind one might momentarily experience upon seeing a loved one about to be hit by a car. It is an anxiety that they then try to mitigate, in vain, with the repeated performance of ritualistic actions.
From the earliest days of human development, the central core of the brain has been focused on cleaning, grooming, warding off danger and other ritualistic behaviors that were necessary for survival eons ago. But after more than 5 million years, these drives have been subdued by the evolution of the more recently developed outer parts of the brain, which are mainly concerned with learning and reasoning. In many of today`s humans, that old central core at times somehow breaks out of its subdued state and, seemingly seeking to regain the dominance it once held in the dim past, wages war against the brain`s outer sections. That, apparently, was what happened in Sydney`s case. ”My brain would go from being modern to being primitive,” she says.
”It`s almost like seeing what the brain may have been doing 5 million years ago,” says Dr. Judith L. Rapoport, an expert on obsessive-compulsive behavior and chief of child psychiatry at the National Institute of Mental Health (NIMH) in Bethesda, Md. ”The handwashing makes me think of the grooming that apes do. There`s a lot of symbolic warding off of danger here that seems to be at a primitive level. We have, for instance, a set of identical twins with the disorder. One washes all day, and the other prays all day.”
Another of Rapoport`s patients, an 18-year-old girl from Maine, took two- hour showers. Each act of dressing had to be repeated precisely 17 times. If she was interrupted in the counting sequence, she would have to start all over again.
Howard Hughes, the billionaire recluse, who went to extraordinary lengths to avoid germs-such as constant use of germicides, handwashing and, in his last years, completely shutting himself out of the outside world-probably was a victim of obsessive-compulsive disorder.
The leading obsession found in a study of afflicted children and adolescents was concern or disgust with bodily wastes or secretions and with dirt, germs or environmental toxins, says Rapoport.
That was followed by a fear that something terrible might happen to oneself or a loved one; concern for symmetry and order; excessive praying; and preoccupation with lucky or unlucky numbers, forbidden or perverse sexual thoughts and intrusive nonsense sounds, words or music.
Heading the list of compulsions was excessive or ritualized handwashing, showering, bathing, toothbrushing or grooming, Rapoport adds. Next in the order of frequency were the repetition of such acts as going in and out of doors or standing up and sitting down; repeated checking of doors, locks, stoves, appliances and car brakes; repeated touching of various objects;
ordering and arranging things as means to ward off danger; counting; and hoarding or collecting.
Because of the stigma attached to mental disorders, most victims of obsessive-compulsive disorder have become masters at concealing their embarrassing impulses and actions. That is why the problem has been hidden until just recently.
”I was good at hiding my symptoms,” says Sydney. ”I did well in school and even became president of my class. But they didn`t know that if I got a
`B,` I would feel like the world was coming to an end, or that if things weren`t perfect or symmetrical, I would feel like my life was coming apart.” Doctors see the symptoms every day, yet they are usually unrecognized for what they are-compulsions. Dermatologists treat chapped hands from overzealous washing, dentists see lacerated gums from prolonged toothbrushing, plastic surgeons are consulted repeatedly about fixing ”abnormal” body parts, family practitioners are puzzled about complaints of ”counting” or ”checking” and internists try, unsuccessfully, to reassure patients who, despite negative test results, are convinced they have AIDS.
Sydney`s first child died at birth, driving her obsessive thoughts and ritualistic behavior further out of control. She had three other children, and as they grew up, she made them prisoners in their own home. No one but Sydney, for instance, could go to the refrigerator or touch anything in the cabinets out of her fear that the children would upset the order of the things in them. In addition to her maternal chores, she spent countless hours each day cleaning-and cleaning over and over again what she had just cleaned. ”I would scan the carpet to get every minute particle off of it,” she says. ”I would sit on the floor after taking care of three babies during the day and take Scotch tape and pick up the hairs on the carpet. That`s after I had already vacuumed. And we didn`t wear shoes in the house, either.
”I would clean a bathroom that hadn`t been used, just because I had a schedule of things that I did every day,” says Sydney. ”I even washed my keys and my checkbook.”
The most agonizing moments for Sydney came when other people entered her house. She would make mental notes of everything they touched and every step they took. After they left, she would wash everything they had handled and every spot on the floor where they had stepped.
”If someone came into my house and went to open something, especially things that were closed, it was almost like they were touching my insides or something. It was bad enough if they touched something that was lying on a table, but if someone went to open something, like a drawer or a closet, it felt like I was being molested. I work as a volunteer for a rape crisis center. The way rape victims describe how they feel when they`ve been raped is how I would feel.”
Sydney`s disorder reached the point where it was totally disabling. She couldn`t function. Her children no longer had friends over, because of her weird house rules, and her marriage ended in divorce. She sought help from psychiatrists, psychologists and social workers, but to no avail. Her life was a nightmare.
”There you are, an intelligent person wasting your life, and you know it, but you can`t do anything about it,” she says.
That`s the way most victims of severe forms of obsessive-compulsive disorder ended up-withdrawn, disabled, unable to control their obsessive thoughts and compulsive behavior, yet knowing that these thoughts and actions are senseless, even stupid. Worst of all, the disorder was untreatable.
Until now, that is. Armed with new studies revealing that a large number of people are affected by the disorder, with imaging machines that track chemical malfunctioning inside the brain and with experimental drugs that quell the primitive obsessions and ritualistic cravings, researchers are hopeful for the first time that the devastating disorder can be overcome.
In fact, in just the last few years obsessive-compulsive disorder, once seen as a rare and untreatable affliction, is now regarded as a relatively common problem resulting from errant brain chemistry and, in most cases, quite treatable.
