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."

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