Mental Illness in Film Research Paper
Obsessive-compulsive disorder (OCD) is a condition distinguished by troubling and intrusive thoughts (obsessions) as well as repetitive and ritualistic behaviors (compulsions) that significantly cause distress or impair functioning (Lack, 2012). According to Fenske & Schwenk (2009), obsessions cause a massive increase in distress and anxiety and compulsions are aimed at reducing the associated distress or anxiety. According to Fornaro et al. (2009), individuals with obsessive thoughts were traditionally said to be possessed. However, today there is a medical view to obsessions and compulsions. While obsessions and compulsions are part of our lives for instance when one returns to check if the door is locked, very few recognize that their actions can be classified as a disorder. This paper describes OCD by discussing its diagnosis, etiology, prevalence, prognosis, signs and symptoms and treatment with a direct reference to the character Howard Hughes from the film The Aviator.
Explanation of Disorder
OCD is a common anxiety problem associated with disabling effects evident throughout a person’s lifespan and has been associated with more than 50% of cases of serious anxiety. In the US, OCD has a lifetime prevalence rate of about 2.3% and 1%-2.3% in adults and children as well as adolescents below 18 respectively (Lack, 2012). Also, 5% of the population experience a sub-clinical OCD portrayed by symptoms that are not disruptive or disturbing enough but still cause impairment to some extent. According to Pittenger et al. (2005), OCD can begin in childhood but it most cases starts in adolescent and early adulthood (between 22 and 35 years) with the onset in men being earlier as compared to that of women.
Scientific evidence has shown that various factors such as genetic, social, biological and immune factors together with family predisposition are instrumental in the etiology of OCD (Fornaro et al., 2009). There is evidence that OCD patients may have similar symptoms to those of relatives with the same condition at a rate of 8% thereby explaining the genetic component and that those individuals may have a common neurobiological basis (Fornaro et al., 2009). Parenting styles can also cause OCD by triggering children to behave or carry out certain activities in a specific manner for instance when a parent insists on hand washing repeatedly.
The DSM-5 diagnostic criteria act as a manual that guides mental health professionals in diagnosing OCD. The professional conduct psychological evaluations to determine if the patient meets the criteria for OCD as outlined in DSM-5 (American Psychiatric Association, 2013). OCD is characterized by obsessions (recurrent, troubling and intrusive thoughts) and compulsions (repetitive and ritualistic behaviors). According to the DSM-5 diagnostic criteria, it is the time-consuming obsessions and compulsions that cause significant distress and impaired function (Fornaro et al., 2009). As such, the disturbances ought not to result from direct effects a general medical condition or a given substance (CDC, 2016). The DSM-5 diagnostic criteria provide that the symptoms must meet the specific and general features of OCD American Psychiatric Association, 2013). That is, one has to have obsessions and compulsions that impact daily life whether they are aware of their unreasonable and excessive nature or not. People with OCD experience common obsessions including, worries about harm, fear of contamination, the need for order and exactness, forbidden thoughts among others. These obsessions are unavoidable and unwanted. Examples of compulsions include counting, cleaning or washing; tapping, routinized behaviors just to mention a few (CDC, 2016). However, making an OCD diagnosis is not easy as individuals may have symptoms that may be similar to those related to anxiety disorders and other mental illnesses.
According to Lack (2012), the OCD prognosis was very poor about three decades ago because there were no effective psychological or pharmacological treatments. However, that has changed today because those treatments with remarkable effectiveness to most of the patients are available. Fornaro et al. (2009) add that many patients fail to seek medical assistance until they develop milder forms of OCD and therefore experience more distress and treatment become possibly harder. As such, early diagnosis and treatment increase the chances of treatment effectiveness.
Brief Summary of Film
The Aviator is an American biographical film produced in 2004 directed by Martin Scorsese. The movie revolves around the character Howard Hughes, played by Leonardo DiCaprio. The film depicts Hughes’ life as an aviation pioneer and also a successful film producer who experienced simultaneous instability resulting from severe OCD. At nine years of age, Hughes was warned about diseases by his mother, and fourteen years later, he began directing films. At one point, Hughes becomes obsessed with film shooting and decides to shoot films realistically. Hughes is also a driven aeronautics engineer and a lady’s man. Hughes continues to engage in aviation activities that make him successful and famous. Paranoia steps in when he was laid off his job, and an FBI investigation causes significant psychological trauma and deep depression. The character Hughes had symptoms of OCD which were at times incapacitating.
Diagnosis of the Character
My OCD diagnosis for Hughes was reached using the DSM-5 diagnostic criteria. From the film, it is evident that Hughes was suffering from OCD because he has signs and symptoms of having obsessions and compulsions. For instance, Hughes had contaminated-related fear possibly resulting from his mother’s warning about diseases when he was nine. For that reason, Hughes is portrayed in the film to have precautionary behaviors such as requesting unopened milk bottles, excessive washing of hands among others. The complexity and severity of such symptoms of OCD increase as the film progresses. Hughes starts to repeat words and phrases in a compulsive manner and comes up with elaborate routines that he must follow always. The compulsions become uncontrollable at times for instance when he engages in hand washing until he bleeds. Other aspects of Hughes’ obsession and compulsions relate to his perfectionist personality. For instance, a film or airplane design had to meet his exact specification. Furthermore, promiscuity, high risk-taking are aspects that can have an association with OCD. When experiencing trauma, OCD symptoms of the character increased.
Hughes meets the DSM-5 diagnostic criteria for OCD because the obsessions and compulsions described above are present most of the days, result in marked distress, impair normal functioning and are time-consuming American Psychiatric Association, 2013). Furthermore, there is no evidence that his obsessions and compulsions are resulting from the physiological effects of any medication or a medical condition.
I feel that the film, The Aviator, accurately provides a real-life portrayal of an individual with OCD in Hughes. However, the film depicts a moment when Hughes had to go for the Senate hearing, and he had to ignore and abandon his OCD routines. As indicated by Fenske & Schwenk (2009), such rapid positive change is rare in real life.
Currently, available treatments for OCD involve pharmacological and psychological interventions. According to Fenske & Schwenk (2009), selective serotonin reuptake inhibitors (SSRIs) including fluoxetine, paroxetine and fluvoxamine are the first line of treatment for OCD as they lead to improvement in 60-70% of patients taking them. Fenske & Schwenk (2009), also report of a Cochrane review that confirmed SSRIs effectiveness in OCD. According to Lack (2012), SSRIs use in adults has large effect sizes (0.9) but moderate in youths (0.46). Fenske & Schwenk (2009) also report the effectiveness of psychological treatments such as cognitive behavior therapy where elements of exposure, as well as response prevention, are addressed. Specialists educate the patients on how to confront situations that trigger obsessions and how to avoid a response to the obsessions by performing compulsive behaviors. In fact, Lack (2012) adds that cognitive behavioral therapy is superior and its relapse rates are lower than those of medical interventions. Fenske & Schwenk (2009), give an example that if a person has a fear of touching objects, they can confront that fear by touching objects until that anxiety dissipates. All the same, education and support is equally important during treatment.
While the character in the film received no treatment, I think the most effective treatment for Hughes would be a combination of pharmacological and psychological interventions as described by Fenske & Schwenk (2009). I would recommend that he fluoxetine. I would also recommend him to attend cognitive behavior therapy with a specialist where he can learn to overcome his fear of contamination. Therapy sessions can help identify the obsession triggers and developing an exposure plan. For instance, he can be made to touch objects until the fear that he might get infected subsides. I believe that daily sessions of about 2 hours each coupled with medication can effectively help him overcome OCD.
To begin with, I have to say I enjoyed watching the film to complete this task. The film and research have helped me realize that there are many individuals with OCD yet they do not recognize that they have a problem just like Hughes in the film. It is, therefore, important to be careful to ensure our fears do not lead to conditions like OCD which can reduce our quality of life. I feel that if Hughes had seen his attention to detail and fear of contamination as a problem, he would not be experiencing trauma and depression due to the progression of his condition. Doing research on this topic has also made me realize I may develop OCD as I always double check almost everything. I feel challenged to stop this behavior as soon as possible.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
CDC,. (2016). Diagnosing OCD | Tourette Syndrome | NCBDDD | CDC. Cdc.gov. Retrieved 8 December 2016, from http://www.cdc.gov/ncbddd/tourette/ocd.html
Fenske, J. N., & Schwenk, T. L. (2009). Obsessive-compulsive disorder: diagnosis and management. American family physician, 80(3). 239-245.
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Pittenger, C., Kelmendi, B., Bloch, M., Krystal, J., & Coric, V. (2005). Clinical treatment of obsessive compulsive disorder. Psychiatry 2(11). 34-43