Tormenting Thoughts and Secret Rituals: The Hidden Epidemic of Obsessive-Compulsive Disorder - Hardcover

Osborn, Ian

Hardcover

ISBN 10: 0679442227 ISBN 13: 9780679442226

Publisher: Pantheon, 1998

Synopsis

Obsessive-compulsive disorder has been called the "hidden epidemic": only a very few of the many people who have it reveal their condition.  Ian Osborn is one of those who suffers from OCD, and his personal experience imbues this book with an exceptional clarity and understanding.

Dr. Osborn discusses the various forms OCD takes and--using the most common focuses of obsession--presents detailed and dramatic cases whose objects are filth, harm, lust, and blasphemy.  He explains how the disorder is currently diagnosed, and how it differs from addiction, worrying, and preoccupation.  He summarizes the recent findings in the areas of brain biology, neuroimaging, and genetics that show OCD to be a distinct chemical disorder of the brain.  He contrasts OCD with other "OCD spectrum disorders" such as anorexia nervosa and hairpulling, and he provides a historical overview that traces the development over the centuries of both behavior therapy and medications.

About this title

About the Author

Ian Osborn, M.D., is a practicing psychiatrist at State College, Pennsylvania, and a specialist in the treatment of OCD.  He lectures frequently to mental health professionals and to the general public.

From the Back Cover

"Dr. Osborn has written a splendid book on OCD--lively, lucid, informative, and scholarly. Blending case histories from his practice with intriguing bits of history and biography, Dr. Osborn has provided both the general and professional reader with a helpful and engrossing account of this serious disorder."

--Ronald Pies, M.D., clinical professor of psychiatry, Tufts University School of Medicine

"In Tormenting Thoughts and Secret Rituals, Dr. Osborn presents an excellent and very practical overview of OCD and its treatment. Equally important, his presentation is spiritually uplifting and openly addresses the crucial role of faith in overcoming OCD. A marvelous achievement."
--Jeffrey Schwartz, M.D., associate professor, UCLA School of Medicine, and author of Brainlock

"Dr. Osborn provides a remarkably complete survey of obsessive-compulsive disorder from sixth-century 'cures' through famous OCD sufferers over the past four hundred years, right up to current state-of-the-art research into the neurobiological causes of OCD. Yet despite his breadth, Dr. Osborn speaks to the OCD sufferer and his family in a highly personal way, encouraging them to consider the variety of treatment options available to help them. I heartily recommend this beautifully written book to all sufferers of OCD."
--Lee Baer, Ph.D., author of Getting Control: Overcoming Your Obsessions and Compulsions; director of research, OCD Unit, Massachusetts General Hospital; and associate professor of psychology, Harvard Medical School

From the Inside Flap

mpulsive disorder has been called the "hidden epidemic": only a very few of the many people who have it reveal their condition.  Ian Osborn is one of those who suffers from OCD, and his personal experience imbues this book with an exceptional clarity and understanding.<br><br>Dr. Osborn discusses the various forms OCD takes and--using the most common focuses of obsession--presents detailed and dramatic cases whose objects are filth, harm, lust, and blasphemy.  He explains how the disorder is currently diagnosed, and how it differs from addiction, worrying, and preoccupation.  He summarizes the recent findings in the areas of brain biology, neuroimaging, and genetics that show OCD to be a distinct chemical disorder of the brain.  He contrasts OCD with other "OCD spectrum disorders" such as anorexia nervosa and hairpulling, and he provides a historical overview that traces the development over the centuries of both behavior therapy and me

Reviews

As many as six million Americans may suffer from obsessive-compulsive disorder (OCD), making it one of the most common mental diseases. Osborn had a bout with it while in medical training, and he narrates the unfolding understanding of the disease and its treatment informatively and readably. In medieval times, many felt that the disorder had a religious basis. Later, puritanism imputed it to sinning, and psychoanalysis "proved" that it had deep psychological roots. Osborn shows that OCD is caused by a chemical imbalance in the brain and that behavior therapy and drugs, preferably together, can take care of it for most patients; Osborn personalizes this part of the discussion with case histories of individuals rather than stick-figure textbook abstractions. He also mentions new research, such as that which finds a possible link between OCD and childhood streptococcal infections; brain injury and stress may also play causative roles. He concludes with a long list of OCD support groups and other helpful information. William Beatty

Excerpt. © Reprinted by permission. All rights reserved.

Prologue: A Personal Perspective

I suffered obsessive -compulsive disorder myself while in medical training. Terrifying, tormenting thoughts often popped unbidden into my mind, causing surges of panic and piercing discomforts. The thoughts usually took the form of vibrant, violent images, for instance, of a knife being thrust into my flesh, or of my nose being scraped right off in a car accident. A particularly frequent one was that of my hand being punctured by a phlebotomy needle. I would have the sudden, intrusive image of me standing at a patient's bedside ready to draw a sample of blood: I unsheath a large-bore phlebotomy needle, menacing, daggerlike in its appearance, and then inexplicably, instead of inserting the needle into my patient's vein, I thrust it to the hilt into the thenar eminence of my hand. Upon the occurrence of this frightful fantasy, my hand would ache in a manner that seemed indistinguishable from genuine pain. I would shake it to make it feel better.

It was fortunate that these troublesome intruders into my consciousness rarely struck when I was engaged in important activities and that therefore they did not upset my medical career because they were impossible to fend off. The more I resisted them, the worse they became. I often used counter-ideas, or restorative images, to neutralize them. To counteract the phlebotomy-needle thought, I would imagine an impenetrable cream covering my hand. The needle would strike and promptly burst into pieces. The image would fade. Yet the tormenting fantasy would always return at another time.

What I suffered, I learned later, was a typical form of obsessive-compulsive disorder. My tormenting thoughts were obsessions, and my counteractive ideas were compulsions. I know now that by fearing them and fighting them, I only made them worse. But back then I didn't know any better.

What did I do for help? Since I later went on to study psychiatry, you'd think that I might have gotten therapy: probed into my unconscious, teased apart my ego defenses, scrutinized my childhood--at the very least, come to some sort of an understanding of my problem. Nothing of the sort. When my obsessions were not bothering me, I didn't want to think about them. I kept my tormenting thoughts a secret, as most OCDers do. Given the treatments that were available back then, it was probably just as well.

In the early I970S, mental health professionals knew next to nothing about obsessive-compulsive disorder. The field had come no further than had the great psychoanalyst Sigmund Freud, who candidly admitted that OCD baffled him. His own theories on the subject, Freud once said, were no more than "doubtful assumptions and unconfirmed suppositions."

When I was in training, the psychiatrists, psychologists, social workers, nurses, and counselors who treated OCD sufferers had trouble just identifying obsessions when they saw them. The self-tormenting thoughts were considered rare, and as a result they were rarely recognized. Severe cases were routinely misdiagnosed as hallucinations; mild ones were written off as examples of obscure unconscious conflicts.

On those occasions when OCD was correctly diagnosed, treatment was next to worthless. They tried years of psychoanalysis, counseling, and group therapy; they prescribed antidepressant medications, antipsychotic medications, even shock therapy; but therapists themselves believed that OCD was a dark and mysterious illness, essentially incurable. That's what I was taught in medical school. If a patient had severe OCD, my professors would just shake their heads, intimating, "We'll do our best, but don't expect much." One clinician of that era wrote, "Most of us are agreed that the treatment of obsessional states is one of the most difficult tasks confronting the psychiatrist, and many of us consider it hopeless."

The good news is that times have changed.

The study of OCD has undergone a truly remarkable shift in emphasis, as researchers have turned away from unproven theories and jumped with both feet into the research lab. As a result of this dramatic change, our understanding of OCD has leaped forward. At a recent meeting of the American Psychiatric Association, more special reports were presented on OCD than on any other topic. OCD has been referred to as the "hot topic" of the I99OS, and professional journals are overflowing with updates on the chemistry, genetics, psychology, and treatment of obsessions and compulsions. The great news for OCD sufferers is that obsessive-compulsive disorder is now recognized as a common, physical disease for which effective treatment is available.

OCD: The Hidden Epidemic

When I was in training, psychiatrists estimated the incidence of a given mental disorder in the general population by extrapolating from the number of people known to be in treatment. Since back then only a tiny number of patients were diagnosed as having obsessive-compulsive disorder, OCD was thought to be very rare. The figure most commonly quoted for its overall incidence was a minuscule .05 percent.

What was not appreciated back then, however, was how adept OCDs are at keeping their disorder hidden. The effort they expend in scheming and lying often rivals that spent on the disorder. Afraid people will think they are crazy, OCD sufferers don't tell anyone about their illness--not their families or their friends, and certainly not their therapists. As Freud, who did not get much else right about OCD, astutely noted: "Sufferers [from OCD are able to keep their affliction a private matter. Concealment is made easier from the fact that they are quite well able to fulfill their social duties during a part of the day, once they have devoted a number of hours to their secret doings, hidden from view."

The true incidence of obsessive-compulsive disorder was not uncovered until 1983, when the National Institutes of Health announced the findings of the first large-scale study on the rate of occurrence of mental health disorders in the general population of the United States. Researchers went from door to door in five different areas of the country, carefully interviewing 18,500 randomly selected people. The results took mental health professionals completely by surprise: OCD was found to occur in 1.9-3.3 percent of the population! Although some researchers have questioned the reliability of the NIMH study on the grounds that its diagnostic criteria were not sufficiently stringent, there is general agreement that OCD's incidence is at least in the range of 1-2 percent.

The experts had misjudged OCD's incidence by a factor of more than twenty. Instead of 150,000 people having the disorder, millions have it. OCD turns out to be one of the most common of all mental illnesses, with large numbers of people suffering the disease in silence. Harvard's Michael Jenike, a leader in OCD research, has referred to it as mental health's "hidden epidemic."

OCD As a Biological Disorder

When I was in medical school, the leading theory on the cause of obsessive-compulsive disorder was Freud's: Obsessions and compulsions arise from unconscious conflicts between instincts, particularly the sex drive, and attempts at self-control. Once widely accepted, this theory no longer holds sway. Extensive research in biochemistry, pharmacology, radiology, and genetics has now demonstrated beyond a doubt that OCD results directly from an abnormality in the brain's chemistry, a malfunction that leads to faulty firing of the brain's neurons. As succinctly put by Yale Medical School Professor Richard Peschel, "Recent neuroscience research proves that obsessive-compulsive disorder is a physical, neurobiological disease of the brain."

That a physical, not a psychological, abnormality accounts for OCD seems, at first, surprising, but the same discovery has been made in a number of other mental disorders. Neurosyphilis, a severe form of the venereal disease that causes heightened emotions and changes in behavior, and pellagra, a vitamin deficiency that leads to fatigue and anxiety, were once thought to be due to psychological conflicts. Early in the twentieth century, however, it became clear that both were entirely curable, biological diseases. More recently, bipolar disorder and schizophrenia, two of the most severe psychiatric problems, have been demonstrated to be physical illnesses. As England's Richard Hunter, past president of the Royal Society of Medicine, has pointed out, "Progress in psychiatry is inevitably and inexorably from the psychological to the physical--never the other way around."

In the case of OCD it is crucial that this shift in perspective, from psychological to neurobiological, be fully accepted as quickly as possible. For one thing, many people are convinced that if a disorder is called "psychiatric," it is not real. Insurance companies, ever eager to find ways of denying payment, routinely assert this fallacy. What a terrible burden it is for disabled OCD sufferers to be viewed as people who are too weak to deal with life's stresses, or worse, as impostors trying to get out work.

Furthermore, OCD patients themselves readily embrace the new neurobiological view. In the past when I explained to my patients that they had a disorder caused by childhood conflicts, they often promptly disappeared from treatment. In the rural area where I practice, at least, people do not want to hear that they have deep-seated problems resulting from the way they were brought up. Now when I explain to patients that they have a medical disorder--an illness like diabetes or heart disease--they nod in agreement. For those who suffer the disorder, the physical explanation of OCD has the ring of truth.

Most importantly, the unlocking of the neurobiological underpinnings of OCD has led to new and potent treatments for the disorder.

Effective Treatment For OCD

Back in the early 1970s, there were no effective treatments for OCD. Now there are not jus...

Edition details

• Publisher: Pantheon
• Publication date: 1998
• Language: English
• ISBN 10: 0679442227
• ISBN 13: 9780679442226
• Binding: Hardcover
• Edition number: 1
• Number of pages: 325