Exploring the role that Obsessive Compulsive
Disorder (OCD) had to play in the demise of Howard Hughes.
by Charles Pasternak
The Aviator, the film
that won five of this year’s Oscars, tells the story of the
first forty years of Howard Hughes’ life. A man obsessed with
beautiful women (none of whom made it into a lasting relationship
with him), with making movies (none of which turned into classics
in the mould of Citizen Kane, Gone with the Wind or Casablanca),
and with designing – and flying, to his own near demise –
larger and faster aeroplanes (none of which made it into production).
Hughes was afflicted with another obsession, now recognised as obsessive
compulsive disorder (OCD).
The disease is not so uncommon: 1 in 50 of the population is afflicted
with it. OCD is manifested by obsessive thoughts and compulsive
behaviour. Hughes was haunted by the threat of microbial infections
– from food and from his surroundings – and reacted
by avoiding contact with possible sources of dirt and by constant
washing of his hands. Typically of OCD sufferers, he also could
not stop himself from repeating again and again certain phrases
that came to his mind.
Deep within our brain
lies a structure called the striatum. This is made up of two parts,
known as the caudate nucleus and putamen. Each part consists of
a mass of nerve cells, that are involved in the processing of messages
from other parts of the brain. The messages are concerned with sensory
information (like seeing a speck of dirt) and with translating such
information into body movements (like rubbing one’s hands
together). In people with OCD, it appears that the caudate nucleus
may not be functioning properly. Normally the translation of sensory
inputs into motor outputs (moving parts of the body through the
innervation of particular muscles) is smooth and finite: a speck
of dirt is seen, the hands react to wipe it away. End of story.
Any misdirected feelings and stray movements are somehow filtered
out. In OCD the filtering mechanism is faulty. Obsessive movements,
like rubbing the hands together or repeating phrases, results.
with OCD use different brain circuitry in performing a cognitive
task than people without the disorder
Dr Jeffrey Schwartz,
a UCLA neuroscientist and Director of the Westwood Institute for
Anxiety Disorders, advised Martin Scorsese (the Director of The
Aviator) and Leonardo DiCaprio (who played Hughes) on the manifestations
of OCD. He is well qualified to do so. Many of his patients suffer
from OCD and his book, Brain and Mind, is what first drew DiCaprio
to him. The film star then spent many days with some of Schwartz’s
patients. “No one had a clue what the causes of obsessive
compulsive disorder were in those days. As a result, those with
the symptoms were stigmatized and were not properly treated, if
at all”, Schwartz says. Now the situation has changed. Behaviour
therapy, in Dr Schwartz’s hands, appears to be remarkably
successful. It depends on the patient recognising that the thoughts
that lead to his or her particular behaviour result from inappropriate
signals in the striatum and learning not to react to them. The therapy
is not unlike that for curing a phobia of snakes by having a python
placed on one’s lap and learning to stroke it.
treatment consists of teaching the patient a number of steps that
he/she must follow. The essence is to recognise intrusive thoughts
and urges, and to ‘relabel’ them as obsessive thoughts
and compulsive urges. For example, learn to say ‘I don’t
feel that I have the need to wash my hands. I’m having a compulsive
urge to perform the action of washing my hands’.
The technique is the
same for other obsessions and compulsions, like checking doors and
appliances, and needless counting of certain objects (‘I don’t
need to check the door: I know I’ve locked it’, and
so on). The goal is to control one’s responses to the thoughts
and urges, not to try to control the thoughts and urges themselves.
If patients learn to perform these actions on a daily basis, and
continue with these essentially self-taught measures for periods
of weeks or months, their OCD will gradually be cured.
standing in front of his new Boeing Army Pursuit Plane,
Would that my mother
had had the benefit of Dr Schwartz’s method! She suffered
from OCD for most of her life. In her case it involved clasping
and unclasping her hands as though in prayer, while repetitively
muttering words of gibberish. Treatment by the method of the day
(electro-convulsive therapy, that consists of passing currents of
huge voltage through the body) did her no good at all.
was not treated: he simply became a recluse, and died – largely
of starvation - at 71 years of age, alone in a room at the Acapulco
Princess Hotel in Mexico, with the windows and door sealed by masking
Those of you who have
seen The Aviator will recall the last words of the film, obsessively
spoken by Leonardo DiCaprio as Howard Hughes: ‘The way of
the future, the way of the future, the way of the future, …
‘. I believe that the film reminds us of three facts. One
I have already referred to: OCD should no longer be considered a
stigma but a treatable disorder.
The second is that
Hughes’s ambitions did not exclude the making of money. If
Hughes’ legacy is not in his films or his aeroplanes (or in
beautiful descendants), it is in the ultimate success of his financial
transactions. Before he died, he left his entire wealth to fund
what has become one of the largest private medical foundations in
the world: the Howard Hughes Medical Institute. Hughes’ philanthropy
puts him firmly alongside such men as Andrew Carnegie, Sir Henry
Wellcome, and John D Rockefeller. Of what other movie mogul can
you say the same?
The third point concerns
my meeting with Jeffrey Schwartz in Pasadena, California, as a result
of us both being interviewed for a journal entitled Vision –
Journal for a New World. This is the house magazine of an organisation
called Vision. Its aim is to bring the hope that was inherent in
the early Christian Church back to the world – without liturgical
dogma, and to Jews and Christians, Muslims and non-believers alike.
Now what is wrong
Charles A Pasternak
is a biochemist, author of Quest:
The Essence of Humanity (John Wiley, 2003; now out in paper-back)
and founding director of the Oxford International Biomedical Centre
(see www.oibc.org.uk). For
more information about Vision see www.vision.org