American - Symptom and Impairment Presentation, Access to Resources

Symptom Presentation

• In the above clip from the American television series Glee (double click to view), main character Emma Pilsbury spends 48 minutes disinfecting a chair before sitting down to discuss her OCD with a therapist. This is an example of her compulsion for cleaning, presumably as a way to reduce stress/anxiety caused by her obsession with cleanliness. This germaphobe model of OCD is common in western media but only truthfully represents some portion of real life individuals with OCD. Real compulsions vary between individuals and can include counting, checking, or simple repetitive actions. Real obsessions are also not limited only to cleanliness.

• “The Big Bang Theory”: https://www.youtube.com/watch?v=jrzUsHNGZHc. In these scenes there are multiple short clips of “The Big Bang Theory”, here one of the main characters whose name is Sheldon displays a knocking ritual in many scenes on the American television show. He has to knock three times, say the person’s name he is trying to get in contact with and repeat two more times. This compulsive act that Sheldon is displaying is a very detailed ritual. Yes this may seem very excessive but it’s distressing for him. The ritual that Sheldon is going through has to be the same exactly every time. There is a long list of compulsions that many can exhibit also. The “Big Bang Theory” would run for a long 12 seasons and ending in May 2019.  

• "5 Types of OCD Friends You Know And Love" (Link): Buzzfeed, a popular platform of the social media world in the United States, particularly on Facebook and Twitter, often publishes articles of different types of personalities. In this particular post (link is above), they highlight five types of personalities or symptoms that, according to them, are considered those with obsessive-compulsive disorder. First is “the planner”, who has an agenda for everything in their daily life, several reminders for events, and are always on time. Second, is “the always prepared”, who leaves the house ith every possible item they might need for the day, and is no doubt, always prepared for any circumstance that comes their way. Third, is “the sanitizer”, that is always worried about themselves and those around them being clean and free of germs. Fourth, “the picky eater”, that does not eat most items due to an allergy or if it is something related to what they are allergic to (for example, cow’s milk and beef). Lastly, “the organizer” that always keeps everything around them tidy, whether it be their office, closet, or bookshelf.

• “Monk”: https://www.youtube.com/watch?v=1Vr8bwYpaGg. In this scene from “Monk”, the main character Adrian Monk who is a renowned former homicide detective. Having multiple phobias and  has an obsessive compulsive disorder (OCD) which eventally intensify once his wife was murder. In this clip Monk displays a cleaning compulsion, counting strokes while brushing his teeth, the placing of his shirts in order, etc. As he gets himself dress he tells himself that he is doing great, in a way of having “control” of his OCD and phobias. But soon realizes that he doesn’t when he thinks that the doctor placed the pillow on the couch laying down. During this session the thought of the pillow being out of place is heavily on his mind. Finally deciding to get up and fix it and great relief comes from Monk placing it correctly. The show would last for 8 seasons and came to an end in 2009. 

Impairment Presentation

• “Turtles All the Way Down”: https://www.npr.org/transcripts/558534128

Discussing his novel “Turtles All the Way Down”, John Green explains how the main character (Aza) experiences thought spirals which impair her ability to have a physical relationship with another person.

“Well, the thing about a spiral is that if you follow it inward, it just keeps going forever. It just gets tighter and tighter. And it never actually ends. And that's kind of how Aza experiences her thoughts when she gets stuck into this kind of looping, turning, twisting series of thoughts about how… ...she's definitely going to die. And then she has to use these behaviors that she's developed to try to manage that fear.”

He continues on to read directly from the book from Aza’s perspective:

“It's fine. You're fine. Just kiss him. You need to check something. It's fine. Just be normal. Check to see if his microbes stay in you. Billions of people kiss and don't die. Just make sure his microbes aren't going to permanently colonize you. Come on. Please, stop this. He could have campylobacter. He could have non symptomatic E. coli that you could get. And then you'll need antibiotics. And then you'll get C-diff, and boom, dead in four days. Please, just stop. Just check. Make sure.”

Green himself struggles with OCD and writes his characters’ mental health issues in ways that he can personally relate to. The anxiety and resulting thought spiral caused by Aza’s obsession with germs/disease are triggered by her physical relations with a boy. Because of her condition, she is unable to be present for the experience of her first kiss. She ends up pulling away from the boy in order to search for information on her phone about bacteria transfer during kissing. Her compulsions and anxiety interrupt her social interactions and impair her ability to connect with the people around her in a meaningful way.

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•  OCD and OCD-related disorders are often characterized by an impairment in occupational functioning. This impairment could arise from the need to perform compulsive behaviors in the workplace, causing issues with getting work done or disrupting the work environment. It could also arise from behaviors taking up a significant amount of time either at work or causing the person to be late to work.
• Pop culture example: In the U.S. popular culture, the most obvious displays of OCD affecting occupational roles show the opposite of impairment, but rather portray OCD as a sort of superpower that helps people in their job. In shows like “Monk” and books/ movies like “Murder on the Orient Express”, the main character is a detective, who utilizes their OCD to help them be more keen on finding clues. Somehow, the heightened attention to obsessions while doing detective work translates into enhancing their detective abilities.

• A&E Reality Television Series, Hoarders: On the American reality television show, Hoarders, people are brought onto the show by request of a friend, family member or other loved one in an attempt to “cure” the person's obsession with keeping items and/or garbage. The show begins by issuing a statement about what hoarding is, “Compulsive hoarding is a mental disorder marked by an obsessive need to acquire and keep things, even if the items are worthless, hazardous, or unsanitary.'' On many of the episodes, the impairments from hoarding end up in severed relationships with others, developing other mental illnesses, and loss of the living space being habitable. The show also attempts to bring a psychologist/psychiatrist to mediate while the home is being evacuated. There is a sense of exploitation in the people and OCD since the show is meant for viewer consumption and entertainment.

• An example in Popular culture that accurately portrays Obsessive-Compulsive Disorder, and its impairment within social functioning, is brilliantly executed by the character Monica from the hit TV show ‘Friends’.

• When the symptoms of Obsessive-Compulsive Disorder (OCD) impair a person’s quality of life, we consider that an impediment on social functioning. As mentioned, an example from American media that portrays a textbook representation of the DSM-5’s OCD definition is the character Monica of ‘Friends’. As we know, the DSM 5, lists a factor represented in Obsessions is "Recurrent and persistent thoughts, impulses, or images that are intrusive and cause marked anxiety or distress; but are not excessive worries about real-life problems.”  An example of this can be seen throughout the entirety of the show. For instance, in one episode, “The One with Joey’s Porsche” (Season 6-5), Monica is having a conversation with her friends, and discusses how one time her thoughts were so consumed by some dirty cars parked in front of her building, that she had to buy supplies and wash the cars herself. This compulsion demonstrates a physical and mental impairment to her quality of life. She is physically and mentally unable to move past the stimulus until she is able to perform her cleansing retital. Similarly, in another episode her brother Ross is dating a woman with a very dirty house. Monica is so whole fully consumed by the state of Ross's girlfriend's home that Monica loses sleep and obsesses over it for days demonstrating her inability to function until the compulsion is satisfied.

Monica's Cleanliness Plot - Season 1-6

In another episode, “The One with the Butt” (Season 1-6), her characters’ main story line is that her obsession with order and tidiness has become something she finds overwhelming, so she tries to refrain from her compulsions. Even after her friend Rachel cleans the apartment and rearrange some furniture, Monica attempts to prove to her friends, and herself that she can be relaxed and calm about the situation. Here, we see, that Monica then is, "aware that the obsessional thoughts, impulses, or images are a product of her own mind, as opposed to delusional in nature.” Which is as we know, is a key factor in the definition of Obsessive behavior. The episode highlights this with the end credits rolling over a glimpse of Monica awake in bed battling herself over whether or not to just get the shoes. Ultimately deciding she need serious psychological help. The show also highlights OCD rituals as well. Monica demonstrates “Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession;” in her need to eat only even numbers of food such as Tic Tacs, or that she has to have her bedroom clock set slightly faster than her living room. 

According to research done by KR Cromer, NB Schmidt, and DL Murphy for their book, An investigation of traumatic life events and obsessive-compulsive disorder., “the course of OCD is typically chronic, with an increase of symptoms often associated with stressful life events.” Similar to Jack’s example above, Monica’s compulsion for cleaning, could have stemmed from her extreme dieting as a child. Excessive cleaning and the implementation of intense organizational systems work as Monica’s coping method that helps reduce her stress/anxiety caused by her body issues. These obsessions help her to be in constant control of herself and her surroundings, thus minimizing her chances of spiraling out of control, again stemming from her childhood battle with binge eating and her relationship with her Mother.

Works Cited:

Leon, C. L. (2020). Obsessive-Compulsive Disorder DSM-5 300.3 (F42).
Retrieved January 28, 2020, from https://www.theravive.com/therapedia/obsessive--compulsive-disorder-dsm--5-300.3-(f42)

Cromer KR, Schmidt NB, Murphy DL. An investigation of traumatic life events and obsessive-compulsive disorder. Behav Res Ther. 2007;45:1683–91. [PubMed] [Google Scholar]

Hansen, M. (2017). Monica Geller's (In)Visible OCD. Retrieved January 28, 2020, from http://meg-hansen.com/monica-gellers-invisible-struggle-with-ocd/

Kostylev, N. (2007, December 19). TOW The Butt - Monica's Cleanliness. Retrieved January 28, 2020, from https://www.youtube.com/watch?v=BUMS-4lpOk4

American - Access to Resources 

For most people with OCD and OCD-related disorders, the most common form of treatment in America is cognitive behavioral therapy (CBT) or medication in the form of antidepressant drugs. Both of these treatments have been shown to relieve symptoms, but that doesn’t mean that every person is given this treatment. In the state of America’s healthcare today, the only access to CBT or medication requires that you either have insurance for treatment at a reduced price, or enough money to pay without insurance. Additionally, you have to have the ability and support to get to a treatment center of some sort, so things like socioeconomic status, ability status and geographical factors can hinder access to resources. 

Popular culture example: In popular culture in America, OCD is often treated as a quirky feature that many people may have, and not a debilitating mental health condition. In order to find any resources for OCD, pop culture is not the place to look. For example: https://www.buzzfeed.com/peggy/33-meticulous-cleaning-tricks-for-the-ocd-person-i this Buzzfeed article is titled “Meticulous cleaning tricks for the OCD person inside you”. Buzzfeed is a popular platform with articles, quizzes and, apparently, tricks to help your OCD! This article serves as an example of how often times in popular culture, OCD is something that everyone has, and is just a little quirky feature that can be fixed with a Buzzfeed list of “tricks”. This is an example of a “resource” that millions of people in the U.S. would consume, and it is highly inaccurate and stigmatizing. Throughout this article, there are no accurate definitions of OCD or links to any mental health organizations. To find actual help for treatment of OCD or OCD-related disorders, one must look far beyond popular culture.