The Most Extreme Cases of OCD

Last night, I attended the closing ceremonies for the 9th annual Newburyport Literary Festival. I fully expected to enjoy the panel which consisted of four well-respected and best selling authors, Jenna Blum, Andre Dubus III (this year's honoree), Wally Lamb, and Richard Russo and was not disappointed. Unsurprisingly, all four of these literary powerhouses were amusing and engaging storytellers.

One of the stories really resonated with me. An audience member proposed a question to the authors about how and why they write. Their responses ran the gamut as to why and how, but it was Richard Russo's response that was the most interesting. He regaled us with a story which told of his obsessive-compulsive disorder (OCD) that became apparent when he was in college. He became obsessed with playing a pinball game; so much so, he was using all of his food vouchers to play. He admits as far as obsession go, this one was pretty innocuous and other than feeling the pangs of hunger, it was better than becoming a drug addict. Russo also noted that obsessions can never actually be eliminated but they can on occasion be refocused. For Russo, writing is his panacea for his OCD and he stated that if it hadn't been for writing, he might very well be in a psych hospital.

As someone who has a mild form of obsession, I found his story fascinating. Fortunately, my form of obsession is more of a mild mental obsession. I can never seem to turn my mind off of a couple of issues and they just roll round and round in my head - taking up way too much space and causing all sorts of issues, i.e., sleeplessness, sadness, anger, etc.

Curiously, Russo's story led me to wonder about what extreme cases of OCD have been documented. I conducted some research and here's what I found:

Nikola Tesla (1856-1943)

A Serbian America, Tesla is considered one of the greatest inventors of the 20th century. He was also an electrical engineer, mechanical engineer, physicist, and futurist.

In addition to being a germaphobe, Tesla probably suffered from OCD in his later years. He developed a hatred of jewelry and round objects, could not bear to touch hair, did not like to shake hands, and became obsessed with the number three. He often felt compelled to walk around a block three times before entering a building and demanded 18 napkins (a number divisible by three) to polish his silver and glasses and plates until they were impeccable whenever he went dining. He would bewilder guests by estimating the mass of his meal before taking a bite and counting jaw movements while he was eating and would not eat alone in the company of a woman. If he read one of an author's books, he felt compelled to read all of their books (I do this!).

Although an obstacle to social relations, Tesla's obsessions also fueled some of his scientific ideas. Consequently, he left a legacy behind him of impressive accomplishments.

"Jean" - Obsessions and Psychasthenia (1903)

Pierre Janet (1859-1947), a French psychiatrist, published a book concerning obsessions and compulsions in 1903, entitled Obsessions and Pyschasthenia. In the book, he presented case studies of his patients who suffered with OCD. Patient "Jean", a 30-year old man, avoided wearing a certain pair of shoes because they made him think of a woman with whom he was obsessed. The connection was that the shoes had the number "49" on them, and the woman had been age 49 when his obsession with her had begun. If Jean upon waking, happened to view a red object on his right, he needed to find one on his left.

Additionally, Jean was obsessed with health and the possibility of his own death. Janet noted that his patient felt the need to constantly check his own heartbeat and that he became anxious at the slightest irregularity. Despite his healthiness, he was unable to attend funerals or pass in front of his local town hall when the announcements of deaths were taking place.

Jean also had an obsession with his own genitals - suffering great pain as a result - and he would spend days at a time rubbing ointments on the area.

The William Hammond Case (1879)

William Hammond (1828-1900), who served as surgeon general of the U.S. Army during the Civil War and later helped to found the American Neurological Association, coined the term "mysophobia" to describe an obsessive fear of contamination. In a psychiatric treatise, he described a "young lady, aged eighteen" who sought treatment from him for such a condition in 1879. This case is one of the earliest documented cases in history.

The patient’s obsession of contamination increased to the point where she was unable to make contact with any surface without washing her hands. According to her mother, she would do so over 200 times each day. Remember, this was the 19th century, when people weren’t nearly as fastidious about cleanliness as they are today.

Whilst on the street, she had to gather her clothes up to avoid touching other people, as she considered them sources of contamination. When questioned, the woman admitted that her compulsions made no sense but still found that she could not stop acting on them - a common OCD experience.

Martin Luther (1483-1546)

It’s a little known fact that Protestant Reformation leader Martin Luther suffered from obsessions and repetitive patterns of thought, which has led many modern researchers to believe that he was afflicted with OCD.

Luther described feelings of “fleshly lust, wrath, hatred, or envy against any brother,” which constantly “vexed” him and would not leave no matter how hard he tried to block them from his mind. He also experienced periods of “blasphemous” thought that left him confused and disturbed - one of the classic symptoms of OCD that commonly causes sufferers to experience uncontrollable mental images that oppose their normal desires.

Martin Luther also suffered from obsessive doubts; in his mind, his omitting the word enim ("for") during the Eucharist was as horrible as laziness, divorce, or murdering one's parent.

Richard Wallace (1950 - )

Compulsive hoarding is a form of OCD that involves cluttering a living space with items to the point where it can become uninhabitable. UK resident Richard Wallace is an extreme case, a man with a collection of junk so large that in 2011 it took up an area larger than his house. This junk pile was so large that it could even be seen on Google Earth.

Wallace’s hoarded goods included six rusting classic cars and stacks of newspapers going back 34 years. He was unable to use any of the space inside his house and had to sleep and eat in his chair.

A senior planning officer from the Mole Valley Council in Surrey served an order on Wallace in 2009 instructing him to clean up his garden. But Mr Wallace fought the order, explaining that it was his “human right” to hoard.

Still, with the help of his neighbors, Wallace did clear up his garden, removing 30 tons of junk in just one afternoon. Finally, he could walk to his front door again. He has since sought an appointment with a psychologist to deal with his hoarding issues. Wallace's hoarding makes the Collyer Brothers seem almost normal...almost!

"Rat Man" (1907)

A patient who first came to Sigmund Freud in 1907 became a classic case for the founding father of psychoanalysis. "Rat Man" was the nickname given by Sigmund Freud to a patient whose case history was published in 1909. This patient's condition was marked by a number of obsessive thoughts, the most notable of which was an intense fear that his father would be tortured using a bizarre Chinese method involving a rat, as described to him by an army colleague. He also feared a female friend (whom he eventually married).

Rat Man also complained of other obsessive thoughts, such as cutting his own throat with a razor. Freud interpreted the symptoms as the patient identifying himself with the rat and thus having fantasies involving both his father and his female friend.

The patient was later used as a showcase for the psychiatrist’s newly developed method of psychoanalysis, but Freud heavily exaggerated when he claimed to have cured Rat Man completely. A letter to Carl Jung written in 1909 revealed that the patient’s problems continued to trouble him. There is some dispute on the identity of the Rat Man. Recent researchers have decided that the "Rat Man" was in fact a clever lawyer named Ernst Lanzer (1878–1914); though many other sources maintain that the man's name was Paul Lorenz.

Budapest between 1890 and 1900

Johanna H. (1895)

In 1895, Dr. Julius Donath of the University of Budapest treated a young woman who suffered from obsessive and compulsive symptoms, including one symptom that revolved around her fear that she might cheat on her husband. A telegraph employee, Johanna H. was 23 years old and happily married for one year. She went to see Dr. Donath who noted the following: "For the past six months she has developed the compulsive fear that she might commit an indiscretion with a man she has just met or seen; and cannot dismiss from her mind this most improbable situation, given that she is happily married; hence, if someone were to tell her that she has had sex with a man, she would immediately believe it."

Her husband added important details which she had omitted. "The compulsive idea of sexual intercourse with other men can be so intense that she has worn knickers made of strong linen, tightly fitted, closed at the front and back [a sort of chastity belt]; in order not to reveal her condition to anyone else, she made this underwear herself." Whenever the husband had to go out, she asked him to lock her up in the house and take the key with him. If another man was in the house, the husband had to reassure her repeatedly that she had not been near him.

Donath attempted to treat this patient using hypnosis, but indicated that she stopped coming to her appointments after only four hypnosis sessions.

Charles Darwin (1809 - 1882)

Eminent evolutionist Charles Darwin is now also widely accepted to have suffered from OCD. Darwin wrote about various obsessional thoughts and how he could not get away from them. In a letter to a friend he wrote "I could not sleep and whatever I did in the day haunted me at night with vivid and most wearing repetition". The thoughts, as he himself put it, were of "horrid spectacle" including thoughts that his children would inherit his kind of illness and to stop them he would try "closing his eyes firmly" but they would not go away. The bad thoughts during the night were more persistent than those in the day, because at night he was not distracted from them by activity.

Darwin also craved reassurance from others and was self critical and also felt himself to be ugly and would repeat himself hundreds of times the mantra "I have worked as hard as I could, and no man can do more than this".

Mad’lle F (1838)

The case of 34-year-old Mad’lle F was recorded by French psychiatrist J.E.D. Esquirol, and apart from being bizarre, it’s notable for being the first compulsive checking behavior described by a medical authority. Mad'lle F made frequent visits to her aunt's house, habitually wearing an apron. One day, at the age of eighteen, without any known cause, upon going out of the house of her aunt, Mad'lle F was seized by the idea that she might accidentally take something that belonged to her relative. After that day, she would deliberately not wear an apron when visiting her aunt.

This symptom was an early indicator of what would come later -- a complex series of rituals. Upon waking, she would rub her feet for ten minutes in order to make sure that nothing had been caught in her toes or between her nails. She would then turn her slippers over and over, shook them, and would then hand them to her chamber-maid, in order that after having carefully examined them, the maid would assure her that they conceal nothing of value. Next, she would run a comb through her hair numerous times to ensure that nothing was trapped there. Every article of her clothing was examined successively, a great number of times, inspected in every way, in all the folds and wrinkles, and rigorously shaken. Finally, she would vigorously shake her hands and rub her fingers until she was convinced that there was nothing on them. The sheer force of these actions exhausted Mad’lle F as they sometimes would take anywhere from an hour and a half to three hours to complete.

Like many OCD sufferers, Mad’lle F was very aware of the ridiculousness of her condition and rituals but was unable to stop making her compulsive checks. Small wonder, then, that Esquirol described OCD as a kind of “partial insanity.”

Howard Hughes (1905 - 1976)

When it comes to OCD, no one suffered more than legendary aviator, filmmaker and businessman Howard Hughes who was perhaps the closest thing the mid-20th century had to a Renaissance man. Yet his obsessive drive to tinker with mechanical objects (he once re-designed his bed to be more comfortable during a stay in hospital) may have been related to the OCD symptoms he developed later in life. These symptoms included a morbid fear of germs and a bizarre obsession with peas in which used a special fork to sort them by size.

Although Hughes had suffered mood swings and obsessions as a younger man, following his near-fatal plane crash in 1946, the symptoms seemed to get worse. In 1947, he refused to leave his screening room for four months, living entirely on milk, chocolate, and chicken and relieving himself in the empty containers.  He was surrounded by dozens of Kleenex boxes, which he continuously stacked and re-arranged. He wrote detailed memos to his aides on yellow legal pads giving them explicit instructions not to look at him, or speak to him unless spoken to. Throughout this period, Hughes sat fixated in his chair, often naked, continually watching movies.

In a bout of obsession with his home state, Hughes began purchasing all restaurant chains and four star hotels that had been founded within the borders of Texas. This included, if for only a short period, many unknown franchises currently out of business. Ownership of the restaurants was placed in the hands of the Howard Hughes Medical Institute and all licenses were resold shortly after.

Another time, he became obsessed with the 1968 film Ice Station Zebra and had it running on a continuous loop in his home. According to his aides, he watched it 150 times.

Hughes insisted on using tissues to pick up objects, so that he could insulate himself from germs. He would also notice dust, stains or other imperfections on people's clothes and demand that they take care of them.

Towards the end of his life, Hughes’s condition worsened, and the former womanizer began to shun all social contact. At the time of his death from kidney failure, his beard and fingernails had both grown out of control making him practically unrecognizable. He also suffered from malnutrition and reportedly had a body weight of just 90 pounds.