Focus 580; The Boy Who Couldnt Stop Washing: The Experience and Treatment of Obsessive-Compulsive Disorder

Is that there are more people with obsessive compulsive disorder than we thought. There are many people both adolescents and adults probably also children who suffer with obsessive compulsive disorder and for the most part manage to keep that a secret. Perhaps as many as four million people both adults and children have obsessive compulsive disorder. We are coming to understand it a little bit better and some kinds of therapy both behavior therapy and drug therapy have helped some people. We'll talk about obsessive compulsive disorder what it is and some of the treatments this morning with Dr. Rappaport. And as we talk we welcome your questions and your comments if you'd like to call in. Here in Champaign Urbana it's 3 3 3 9 4 5 5. We also have a toll free line which is good to anywhere that you hear the station and that is 800 to 2 2 9 4 5 5. I also would like to mention that E.P. Dutton is the publisher of the book and here is say good morning to Dr. Rappaport. Good morning. Thanks very much for giving us some of your time.

Pleasure. I think that we can help people understand by giving some examples especially to understand the difference between what we might call everyday kind of compulsive behavior and obsessive compulsive disorder. Maybe it would be useful to go right to an example and one should tell us about Dr. s this the man that you profile very early in the book. Well he certainly is one good example is a sector he had obsessive doubts about whether or not he had hit someone when driving his car. And Dr. asked who is a research psychologist and author in his own right a book on stress in the workplace is a very sane man and otherwise are reasonable. But when his obsessed and yet when his obsessive compulsive disorder used to be severe he would spend up to two three hours at a time driving out back and forth along the same route he had

traveled. Checking for a body. Thought maybe he could have hit. Let me get it really clear that this man is really rash and all he have could tell me that there had been no other cars or even pedestrians along the highway. But when he got into the checking routine there went his way and he would be very upset as he did this because he'd be missing an important appointment. Doctor asked have appeared on the Donahue show to describe this himself. That impressed everybody by his otherwise reasonableness. He got a lot of help those we could talk about later for a number of treatments that now is very proud that he can help other people. Yeah one of the things that makes it a little bit difficult to read the accounts in the book. I think your heart really goes out to these people because you can tell that clearly they are tormented by their their bizarre behaviors and what really makes it difficult I

think is that they they understand that they are captives of their behavior they think they know it part in part of their mind somewhere. They know that it doesn't make sense for them to be doing what they're doing at the same time. They can't stop. Absolutely. I like a bit of a book to pick up of the mind because it's at such a distance from most of the patients with it. Sessions and compulsion they come to you and say Do you really have something that I can do or take that will make me stop this. And it's very much like a person with a hick up when the hiccups go away. No one says that you need to make this strange noise. They just say thank God that's over. Well it's the same with the patient. A woman I know who had a her first big break or terrific job as a commercial artist she's been a struggling artist and this was a chance to make a lot of money very excited about that. And she had a version of checking that she would have to see whether her door was locked and she would turn the handle on and start to go down or stop her car and then she'd have to go back and check

once more. So far like anybody right. But two hours later she's still there and it was heartbreaking that she nearly lost this job. She finally was able to get treatment and go back in. And actually they hired her again. But. That she was absolutely desperate. How did how can I get out of this. He'd ask. When you talk about one one kind of group of people that you find when you look at obsessive compulsive disorder and you have given one example and that is the checker the people who continue to have to just like the example with the woman who had to keep back had to keep going back to check of the doors like somehow they can't they can't persuade themselves that they've done that action and have to keep going back and checking. There is another apparently in the most common kind of behavior. And you've titled your book for it is is washing things that have to do either with the person washing themselves or with. It can be their apartment or their home for example that

they continue to have to keep cleaning. Tell me about tell us about. Here's another person you write about in your book a young man. His name is Zach. He when you talk to him he was nine and he has a washer and he says when he was six he began to have this fear of getting his hands dirty and by the time he was seven he was washing his hands. Thirty five times a day. At least we have seen patients when they're in a launching phase over from home watching for the worst problem who washed their hands two hundred times a day. One child with scribing and with Mr. Clean and in the extreme cases of hands can look red and Royce if they have a skin disease. People who shower can be stuck in showers for days at a time. And again as at first you think that's crazy or it's humorous but when you talk to the person there they're absolutely miserable about it.

Zach the boy you mentioned had the feeling iced out of the blue that his son and couldn't feel clean enough and he had had some other compulsive rituals before odd months like having to swallow a certain number of times and being very concerned that he might touch something dirty. But once the hand washing began he like a number of other children put this to experience when he would finish washing his hands. He would have to turn the faucets off with his elbows. In the rare cases when we've had to admit people in our study for who have washing problems to our hospital at the National Institute of Health the nurses had to ration bars of soap a day. And another thing that is fascinating about this this particular kind of people is that it doesn't necessarily correlate with neatness. That is you. I remember one story about and I think it's in that same passage where you talk about the fact that they had to ration the soap that

when some of these people were were in hospitals that the nurses like their parents might have had to were constantly nagging them about picking up their clothes and keeping their room neat so it's odd that it should be such a specially targeted thing. They were you know that it should it should effect part of their behavior and part of themselves and then something else that seemed to be logically related it wouldn't have anything to do with. Exactly. We are all learning that. Pulse of personality. People who are very rigid and may be extremely neat and controlling in a number of ways are often likely to get depressed in the long run. These are people who often alienates their employees their spouses children because everything has to be done just so they're perfectionists the sort of person who can never keep a secretary that no one can live with them because they're always getting a house out of order. According to the person with

compulsive personality those people are likely to get depressed. A great deal because people close to them in fact abandon them. But that's not the same thing as obsessive compulsive disorder and in fact that very specificity to certain things to do with grooming and danger and doorways of certain sorts of thoughts make us have led us to have a whole other theory about obsessive compulsive disorder that it's quite separate from the personality in every day. The other thing that sort of intriguing that you talk about in the book is the fact that when one person with obsessive compulsive disorder meets another if they have similar sorts of disorders that if for example they're both washers they can be fairly sympathetic with one another and yet if if a washer meets a checker somehow they they think the other person is kind of odd they don't seem to have that same kind of

sympathy for them that they would for someone who has the has the similar kind of behavior that is similar to their right. Well the place is getting much more educated about the slaughter through a really phenomenal group that has been developed. The foundation think New Haven Connecticut and that has helped the place. Recognize and support each other. But something else that would have to qualify my own statement in the book and that is that we followed patients now for 15 or 18 years. We find that the symptoms for many of them come in blocks of four or five years. So that one boy I'm thinking of for grade school years he had the count he had to do everything in numbers of five six or seven thousand times which took up a lot of his time and pretty presented one sort of problem in high school he was a more typical patient with a lot of washing and showering for hours in the shower. And as an adult he became overly scrupulous

and would spend hours on end. As a young adult worrying about whether he had done something inappropriate or hurt somebody in some way in their own never really true. So that someone like that would understand people who are in the other spaces. Well this morning let me remind people who may just have tuned in we're talking with Dr. Judith Rappaport the author of the book the boy who couldn't stop washing. It's about the experience and treatment of obsessive compulsive disorder. If you have questions for us you can call in here in Champaign-Urbana 3 3 3 9 4 5 5. Toll free anywhere you hear the station Illinois Indiana Wisconsin toll free 800 to 2 2 9 4 5 5. One of the things that that comes out in your book is also the fact that obsessive compulsive disorder seems to run in families. We talked about Dr. ass who had a son who also had

obsessive compulsive disorder and that we talked about Zach his father has had the obsessive compulsive disorder that would seem to suggest that this is a trait that is genetically inherited. All right. Convinced that it's kinetic from the quarter of our patient at the National Institute of Health for the last 10 years we've been doing interviews for the people in our study and every single member of the immediate family. By that I mean brother sister mother father or children. Just the immediate family and the large they were is that we've now looked at 25 percent of our patients have somebody else in the immediate family with obsessive compulsive disorder. Of course someone can say well does that mean it's genetic why don't they just copying someone else in the family. But we have a good answer to that and that is that most of the time the other family member has a different symptom. For example in our study right now are identical

twins who have obsessive compulsive disorder. They've benefited enough a lot from some of the new treatments. But one of them washes for hours every day. And the other one prays for hours every day over in that he in fact those aren't real. For example he may have he thinks made noises in class disturbing his class but no one else including the teacher heard any noises. And both of them aren't we are sure how to obsessive compulsive disorder and we don't think there's any way that one would have copied their problems from the other side. Apparently one of the things the things that you write about is the fact that for a long time while obsessive compulsive disorder was was known to exist it was recognized and studied. It was thought to be relatively rare and that now we are coming to understand that there are more people with obsessive compulsive disorder than we had thought and that the reason

we at one time thought it was rare is that to a large extent these people are pretty good at managing to keep it hidden and living their lives as best they can even though they suffer with obsessive compulsive disorder. The thing that I wonder is that some of the behaviors that are described are. They're noticeable I mean I don't know how how someone especially someone who was close to this person could not notice and I wonder how is it that these people manage to conceal their obsessive compulsive disorder so successfully apparently in some cases for for many years. That's a good question and I think that it's not as successful in one sense as it may seem. Any of our patients have either divorced or never married. And it's not because they didn't have the opportunity but because if you spend

two or three hours a night either tracking or washing or with one variant of obsessive compulsive disorder in which you're compelled to pull your own hair out if you do these things even if you're very upset you're doing them you're still doing them and they have been very concerned. But anyone who lived with them we wouldn't understand and would think that was a terrible waste of time which it is. So in that sense it's not successful and there's a lot of suffering. But there is a partial voluntary Contro over the symptoms that someone who for example keeps very busy during the day. I have patients who are bank executives who are successful writers. Magazines do all sorts of high powered jobs some of them are able to get through their day and then spend their evenings of their free time doing the ritual. It's it's really fascinating. One thing that I that I thought about as I was reading especially the the account of

Dr S's child and some of the behaviors of that child that it seemed that some of the behaviors that you might see in a child with obsessive compulsive disorder seemed to me similar to those that you might see in a child that was diagnosed as having attention deficit disorder. What we used to call hyperactive and I wonder and you know I may be it may be a misunderstanding on my part but I wonder whether there might be some some kids who are diagnosed as attention deficit disorder who are actually obsessive compulsive. Right and you're very shocked as far as the particular case goes that with Dr. Arthur. I think he had two diagnoses and one with attention deficit disorder and the other with obsessive compulsive disorder and not the final person of his own treating doctors. But. Most of the patients with obsessive compulsive disorder aren't aren't particularly likely to have other disorders although they can. I've seen obsessive compulsive disorder and some

juvenile delinquents for example. They clearly had two kinds of problems. Whatever was causing the delinquency the conduct problem and the obsession compulsion. But. The number of other conditions are varied. That can go along with obsessive compulsive disorder depression is another common one and we think that's often secondary that is if your life is being wasted hours every day. That is a depressing act but you know I'm still thinking of your question. The fact that it's hidden and I think we're really realizing how well people have been concealing this because of the National Institute of Mental Health Survey that suggested that more than 2 percent of people in this country have the disorder. And that really makes it possible that there are five million or more people in this country that have obsessive compulsive disorder and that's a remarkable statistic considering that that that brings it up into the

ballpark of alcoholism the Depression and the phobias and when you think how many books and how much has been written on these other subjects. And here you have a disorder of comparable frequency that no one has ever heard of. Well I suppose that again though goes back to back to the success that many obsessive people with the ocd have had in managing to keep it pretty pretty much under under wraps. Exactly and many there are number of different ways they can hide this one rather attractive woman who is a successful bond holding them and no slouch but she has managed because of her cleaning rituals and curing a compulsion she has to make sure that her eyebrows are symmetrical and that he has a tweezers and will pay rush off to the ladies room secretly in a panic about a lack of symmetry and her eyebrows which are over plucked because it keeps on eating up one side and then she has to be the other. But she

says that at work her colleagues think of her as a kind of a airhead a southern belle type because she'll kind of bat her eyes and say she just had to go and fix her back up and in fact she's really desperate and very unhappy either. People just become rather isolated and aloof and people think they're either snobbish or wonder about their private lives why they never married and so on. Because they need to do this one man again a successful employee of a bank rising in his bank's hierarchy spends more than an hour and a half every night checking his bent and his back yard and the white fence that goes around for a sizable backyard to see if there are any loose board. There's no reason for it his doors are locked and it wouldn't matter if they were bored. But it's a compulsion that people just think of him and that I'm sociable guy. Well I have a caller here and I hope we may have some other folks who have questions for us.

We'll go to the toll free line and talk with this person right here. Hello guy I'd like to hear something about myself and I'd like to say that I find in it a reason for the compulsions that I have myself. And I'd like to say that I disagree with the fact that people in the family can develop different compulsion and yet not have them be from this NG. Carl and I. I'll give you an example per year. And I don't go into detail on it but one in particular I have for years I had after leaving home which was quite early from a very physically abusive crazy mother. I had a very very modest amount of compulsion

and I spent many years with my son for the first time in a month. He thought he would be right but but I had. How would I put it. I had extreme amounts of problems and they would go inside go be hospitalized for different periods and then what. Compulsion I had. Oh oh let's see one of them was pulling out my hair for instance. And that's the one I'm going to use as my example. But I would have assumed I wouldn't stand for hours pulling out my hair and I would stand in front of America for hours doing this to the point where I couldn't get off to school. I couldn't do anything I couldn't dress or anything and I had a lot of different like I had muscle twitches and tics and muscle spasms you know that I felt I had done myself. You know I had to tighten my muscles and and them and after a while they got to be more or less automatic.

But some of the other things you know are more serious. I really don't want to go into them but I had a very very I had a lot of total loss of mind. I lost my mind and I wasn't able to function. Terrible terrible terrible distress and harm. And there wasn't any drug or any help from me. And none of the hostile versions. But I'd like to say that after years I did. I did say some of the things I had. I had locked away in my memory not the things that the abuses that my mother had done to me mostly to my head. The area of my head had battered my head many times for hours at a time every day of my childhood and I knew I remembered that and also family members remember that very distinctly because I was in Corinth over it and she tried to have me locked up and they had taken me away from her. It wasn't that I didn't remember I

didn't remember the seriousness of the pain and I don't remember I don't remember that I had tried to hide from the pain by hiding behind some compulsive behaviors one of which was the polling of the hair. And during the process of my life my adult life my successful adult life I have found that some of these little things shake free and one of them I'd like to share with you was when I was pulling my hair which I still do. I still do this behavior. I found that I remembered I had a very vivid memory. I do a lot of. I do a lot of work with or on my own and also with other people. But some of it one of the things that were pretty was the feeling of calling us air and I felt the pain of much self-inflicted pain of calling it and then I had a memory numbered. When I was a little child my mother had told by her very terrible issues to lift

me up by my hair and swing me around and around the corner. And one of the times I pull my hair that time until I pulled it and I remember the pain and I remember pulling my hair myself as a child because of a particularly painful spot in my head where my mother had battered me with a very heavy an object and I pulled the hair and the more I pulled as a child the more the pain stopped because it covered the pain of the battering and I was able to make a lot of that teaching other to gain some control over that pain as a tiny child. I think it really had a very courageous act by my calling and sharing that with Banquo and I thank Ari and I invite all for me to do that. This one and we're saying that. That I didn't remember that for years and years and I'm not saying I have any better control over it now that I know some of the reasons behind my problems. But I do feel that a lot of people

in families My sister has developed some very serious as well so not serious problems but she developed some compulsion she didn't have anything as hard as I did but everybody developed different ways of hiding their pain and hiding the problems that the world around them has dealt them. And I feel that even if someone in a family develops a different kind we're all individual and Joe OK. And I'd like to say I find this very interesting program. I just feel very strongly that there are reasons for everything that a child. And there are important reasons. We just may not know them until we figure out who we are and what has happened to us and how we chose to deal with it. And and that it's a shame as we grow up we do to choose the same kinds of things and they're different from our sisters and brothers and thanking them. It's OK to go away. I wonder Dr. Repp aboard what you think about that story and especially you know I was one

of the things that I wanted to have you talk about was treatment over the course of compulsive disorder. Well sure the woman who called in that a very courageous thing of sharing her personal experience and it's important in a number of things. First of all it's clear that she's got a great deal of support from therapy which is very helpful when you've had a life of abuse and a life of care for people in your childhood in some ways put trust in very basic ways and psychotherapy for those kinds of problems is very very helpful. But the great majority of the hundreds of patients we've seen with the hair pulling and the other compulsions have had very On remarkable childhoods. People come past after years and years of psychotherapy which helped them learn to trust people with help them with depression and anxiety. But like the woman who just phoned in and not to stop the hair

pulling and the hand washing and the psychotherapy and which I believe can do remarkable things for people particularly for depression. But for people who need to get control over these particular symptoms and particularly the great great majority of people with the hair pulling and the hand washing whose family lives were really on remarkable even after years of therapy of trying to find out what hint what unconscious problems they have. If you just want to get rid of the symptoms the two most important therapies are behavior therapy and several different there were medications that have been developed. But I wanted to be very very clear that this is not an anti psychotherapy statement. But what we're learning in psychiatry is that you need all kinds of treatments and the different treatments are best for different. We have women who have had years of analysis which helped them in many ways and profound ways with relationships with others.

But they were still bald from pulling out their hair if they wanted to stop wearing wigs. The most useful thing were some of these new medicines. We have other people who've years of psychotherapy did as I say helped them understand how to control their relationships or trust people even. And some people found it useful even if they weren't like the majority of our patients whose family lives weren't in any way difficult. We're talking this morning you know with Dr. Judith Rappaport she is an authority on obsessive compulsive disorder and she is the author of the recently published book The boy who couldn't stop washing. Our guest this morning is Dr. Judith Rappaport. She is a child psychiatrist. In fact she is chief of the child psychiatry branch of the National Institute of Mental Health and is an authority on obsessive compulsive disorder. That's where we're talking about here this morning if you have questions we have a couple of local lines open 3 3 3 9 4 5 5 is the number before going on to some other callers I just would like to have you talk a little bit more about treatment for some people who have

obsessive compulsive disorder. They have been helped by using some antidepressant medications. Why don't they want to take a person to carry them. There's all kinds of treatments that are the most effective that have been proven to be effective. As we were talking before psychotherapy has been good for many other things but hasn't been particularly effective for the symptoms of obsessive compulsive disorder and one of the reasons why I wrote this book was in order the three millions of people with OCD would be aware of not only how much company they have of other people suffering secretly but that there's great new hope. There were treatments and I'd rather mention an ombre treatment first because if someone can do something without a drug that probably should go. Behavior Therapy is a form of therapy that's designed to stop particular symptoms. It's not meant to be a replacement for

psychotherapy but for some people it is clearly the most direct and most effective route. An example of behavior therapy is to take someone who compulsively washes their hands a hundred times a day and I pick this example but for a particular reason because behavior therapy is much better when you have a compulsion that is the need to do rituals than with obsessions that are more just thoughts in your head and the hated therapist would work with this and washer and find out. Let's say that touching anything triggers the washing they'd first get a very careful listing acceptance. Let's say if they shake hands with someone turn a door knob etc. they have to go and watch one of the hated therapist for do. I would be over a period of Usually several months work carefully with this person. Exposing them to the thing that sets off these marketing rituals such as shaking hands or touching door knobs and then work with them to deliberately not wash their own jargon would be

exposure with response prevention and by the end of behavior therapy you might be doing really some overkill approaches. For example one woman in the Philadelphia center by the end of her treatment who had been a washer was paying about great people on the streets of Philadelphia 50 cents to shake hands with her as part of her very final rest and that is big for the people who either can't or won't respond to behavior therapy. Those are people who feel they couldn't go through with such a program or people with a lot of obsessions that are much less amenable to that treatment. There are two or three newer drugs and this is where you have to be really careful because most and these new drugs all happen to be anti depressants. There are perfectly good antidepressants but I'm not sure they're anything special. But most antidepressants don't do anything for obsessive compulsive disorder and so it's really important that someone know that it can't be just any anti-depressant.

There's one or that's not yet on the market called clomipramine that doctors can get through the drug manufacturer. There's another one. Call flu aka tea which has come on the market as an antidepressant and the company is applying for a license to end users and obsessions and compulsions. There's another one still in our research phase that will be applying to come on the market in this country. And all three of these look very very promising for the treatment of obsessions and post them for good. Well we have some callers here waiting and let's talk with them. Line 1 or next person. Hello hello yes a question for the doctor. Yes. Question How do you call about in approaching or even suggesting to this person that you have a for this disorder. I mean when it's someone close to you yes very close that that happens to be this.

Up to being a mother in law right and all that is that it's about always being clean which is fine to a certain extent but she's just it has it's like a ritual even if it's clean she still has to clean it over and over and over again. Sure a lot of people. There's a number of dancers I'd have to that first as an author with a new book after lies that a number of people have written me saying that giving the book boy could stop arsing to their husband or their sister or in one case their boss saying you have been very helpful but you have to know the person and depends on what your relationship is as a physician I have learned that are often a lot of clues a person gives a day and tells me what I can tell them you know the patient that says what the good news is they're asking for one message where someone else it says Tell it to me straight is asking for another. So yeah you have to use Of course your instincts with this but I think you might say well I heard this radio program for

a fault and I seen your show on Donahue and there was one lady there that I think that this guy also. And I think the main thing is that another thing is the OCD Foundation is starting support groups for people with the disorder and just as important for families of people with the disorder. What I was thinking about doing is you know I haven't bought the book yet but I was going to this week and just take it with me when we hear this month and just you know either just given it to her and you know just don't be so blunt about it but just try to express my feelings about her and what I think is going on. There are some people many people with obsessive compulsive disorder just are really DO acknowledge it and say I just can't help it I can't stop. And it's been their own fear that they couldn't do anything about it that makes them not want to talk about it. But in other cases it could be that a person is just very defensive and then you have to be careful going to make things worse.

That's right. OK well thank you so much for the information or good luck nothing someone else you're holding on our line number two. Oh yeah. Doctor I want to thank you for the book very helpful on our case. But I've cried. If you have it happen after that that they have. Put that week off. I've tried see if I have it. I don't have the file they can just have their address. Post office box 9 5 7 3 in New Haven Connecticut and it's 0 6 5 3 5 is that it. And I've been told by people that the foundation gets back very promptly with these letters and application forms of things like that. They are they are very very good at putting people in touch with the right people or facilities whatever

part of the country there are you surprised. Take your help Doctor. You're very welcome I thank you. The comment about 10 minutes left. Again our guest is Dr. Judith Rappaport. We're talking about obsessive compulsive disorder and she's the author of the book the boy who couldn't stop washing. I wonder Dr. Rappaport as as you think about obsessive compulsive disorder whether you feel that it is somehow an extension of what we might call a garden variety obsession or whether somehow there it's not a continuum and at some point there's a break in obsessive compulsive disorder just kind of jumps off the scale. And maybe in fact it's something different and it's not related to a less problematic behaviors that maybe almost everybody has. We think it really is something different. We have people with normal everyday behaviors even a very strong one. But they do. Seem to turn into

obsessive compulsive disorder at all. And we think that there's a much more profound meaning in the pattern of these symptoms that we think in an evolutionary way that many of these are behaviors that at a very primitive level are hardwired into the brain. We think that the here pulling is maybe severe nail biting and the washing can be grooming behaviors running wild in an evolutionary sense could have been very adaptive at some time in our development. And there's a number of studies several of our own that show that there's a particular system in the brain an open system of the brain called the days old ganglia in which something is being sparked off so to speak in obsessive compulsive disorder. And we have taken a lesson from the lethality of the study of animal behaviors particularly animal behaviors that seem to have a big inherited

component. And we now have an animal model for obsessive compulsive disorder and we the new drugs help specifically with some of these animal grooming behaviors run wild. We have studies going on with very very severe now abiders. I mean the kind whose hands look like they've been in an accident because bankers are bleeding and the most severe form these new wimpy obsessional drugs work for that too. We have brain imaging studies that show that part of the frontal lobe and part of the basal ganglia are lit up in these patients with obsessive compulsive disorder and not in the normal controls and not in other psychiatric conditions in the same way. And when we put all of this enormous amount of different information together it points to a very biological system that somehow gets triggered triggered off. But we see these as really so logical that is

related often to animal type of behavior or conditions that are just running wild you know sort of preps to think about it in to make a computer analogy it's as if there was a some program that would lead to a certain kind of behavior that at one time would have been. Productive there would have been good reasons for it and it's something that perhaps a long time ago we stopped needing and yet the program was still buried there somewhere and that in some people something is happening to start the program running and it's just running out of control. That's exactly it. I'm not the first to think of this although I'm the first to be printing out for obsessions and compulsions but people studying phobias for many years have commented on the fact that if it was rational people would be phobic about highways and guns but instead look like phobias focus on and sex and being trapped in small spaces and battles are more relevant to ancient

than a base of man over evolutionary time and have nothing to do with the biggest real danger but to take another caller we have someone on our toll free line. Hello. Hi it's me again I just would like to clarify something that I did. I guess I didn't make clear on my first call. I think it helps that I receive with all the problems that I was the only real help that I received with the help that I got from people from regular human being who had were able to share with me their own their own feelings most of what I heard from all these people that were able to help me was that there was nothing wrong or strange about me and that everybody. I had something that they didn't like to share or that were personal to them and they didn't really like especially about themselves or they found compulsive or you know everybody here had something and people were able to make it you know it wasn't all me. It wasn't only me you know this may not work for everybody but

one thing I'd like to say else is that when I did some community work with. We're in a mental hospital in Elgin Illinois I did work with I was community gas and there were patients of the hospital working together for a new kind of program where everyone and I got money and came directly from the government reworking a huge grant with Dr. Norma Jean Orlando and one of the experiments that she did which she took. If you take it you took an old idea and you made it into the mental hospital mold she took the patients in the hospital and she switched roles with them with the staff and she put the staff behind the bar and the patients outside and they were fed regularly and treated like the patients were treated and they found that after a week or two of this that the pay that the staff was had the same reaction that the patients had they had developed the same kind of

symptoms the walking symptoms the hair pulling the nail biting the walking the holding on that that last look and the feeling that they had lost their mind. And each one of them described very vividly. And she did this is a study she has published it and she showed she had it on television. She showed that really a lot of times and I'm not disputing the biological but I'm just saying that a lot of times the way we react in the way we're treated like what the symptoms that we show and I think that that's one thing that shows this and the other thing is in the body the body will I think come along if you if you if you do treat your body to a certain compulsive behavior over and over I believe that it does it does make certain chemicals more prevalent in your body. And so I think you can read it both ways when you have when you read some biological thing. Better Way to hold some of those experiments too is to look at the person before they

become what they will become and if you do find the physical things and if they do hang out and OK thank you. OK I think you some reaction to that point very well but we don't have some prospective studies with children live in the day and have very good records from their schools and parents and children. We can crank I have a right to see if there are any predictors for this to the terms of the study. I think think of the normal within their families and there before they became ill. Going back but. We've also done the epidemiological study of other people to see if there's anything unusual in the family home population. But I think it's very eloquently put across America for addressing. I think are not directly related issues but how important the general attitude of participation in very important psychotherapy and very interesting

research going on. That sounds like it's an awfully good work and very eloquently described are not directly relevant but are Sounds like awfully good start he's describing. Well let me ask you let me ask you this if I think that you say in the book that something like half of the. Half of the adult obsessive compulsives say that or maybe it's your feeling that half of them began to develop their symptoms when they were children. Oh absolutely that's true and everybody's experience it is is it does it does it help that is can is treatment more productive. If you can intervene when the person is a child or when you working with adults is it is it about as effective when you're trying to look at right now trying to get the answer. Certainly I think it's likely that if half of the 6 billion people started in childhood at that it would make very good that the START Treaty people want their children

because the effect on relationships of the family can be devastating. Brothers and Sisters very much the attention these children receive in the isolation of an adolescent terrible for their personal and professional development. But we don't have the data to answer that question. Well we will have to leave it at that. I want to thank you very much for being with us. Thank you very very interesting topic. I appreciate you giving us some of your time. Thank you. And also I will recommend if there are people who are listening who would like to read more about this about obsessive compulsive disorder. You can look for the book that we've been talking about the title is The boy who couldn't stop washing. It's published by E. P. Duggan by our guest Judith Rappaport. She is chief of the child psychiatry branch of the National Institute of Mental Health.