Tuesday, July 22, 2014

OCD and the malleable brain

The 2004 film ‘The aviator’ tells the real life story of Howard Hughes (1910-1976), the American business tycoon. Played in the movie by Leonardo DiCaprio, Hughes was a filmmaker, investor, inventor, aerospace engineer, real estate magnate and one of the richest man in the world of his time. An unparalleled aviator who held many flying records, he was one of the pioneers of the aviation industry.
Hughes’ later years however were spent suffering in the grips of a terrible disease – the Obsessive-Compulsive Disorder, or OCD for short. He lost his health and reputation and spent most of his time alone. He degenerated so much that he was unrecognisable when he died under mysterious circumstances – this 6’4’’ tall man weighed only 40 kg at death!
A cruel and unforgiving mental disease, OCD affects one in every 40 people. The patients of OCD experience two types of mental activity. The first is called the Obsession. These are disturbing and intruding thoughts like – ‘My hands are dirty’, or ‘I haven’t locked the door’. The feeling of something being wrong is very strong and it possesses the patient’s mind completely.
The second kind of mental activity is the ‘Compulsion’. Harried by the obsessive thoughts, the patients gets an overwhelming feeling that they must do a specific action to undo the wrong. Under the influence of this belief, the patients do things like washing their hands or checking the lock. But the relief in obsessive thoughts that this action brings is short. The thoughts strike again, and patient is forced to act one more time. This cruel cycle goes on. Patients loose peace of mind, many are unable to keep a job or relationship and some think of suicide.
The thoughts like hand being dirty or not having locked the door are well known examples of obsessions, but there are numerous more forms that these thoughts can take. Strong violent, sexual or religious urges, doubts of a cheating partner, mistakes in documents, neatness of clothes… there is long list of obsessive thoughts that doctors of OCD patients have noted. Similarly, compulsive actions also range from washing and checking to saying specific words again and again. The man in our case study- Howard Hughes- was known to be obsessive about many things, including neatness of blouses of his film heroines. As an example of compulsion, he is supposed to have watched the movie ‘Ice Station Zebra’ 150 times!
In the 1990’s scientists found that OCD is caused by a faulty wiring of the brain. Two parts of brain – the Orbito-Frontal Cortex or OFC and the caudate nucleus, become locked with each other in such a way so as to produce extra activity. This hyperactivity gives rise to the feeling of ‘something is terribly wrong’ and ‘I have to do such-and-such’.
Dr. Jeffrey Shwartz of University of California at LA (UCLA) formulated a therapy called the ‘Four Step Therapy’ for OCD in 1996. This therapy is based on the Mindfulness Meditation practiced by the Buddhist monks. In short, the four steps are:
Relabel – when the obsessive thoughts come into your mind, recognise them as OCD thoughts and not facts. ‘This is OCD, not me’.
Reattribute – understand the brain mechanism (the OFC-caudate nucleus embrace) behind the thoughts and learn to attribute the thoughts to that mechanism.
Refocus – instead of compulsive action, learn to do something else, such as gardening or walking. Do not suppress, just postpone the compulsive action, and focus instead on another task.
Revalue – after a few months of this therapy, the patients learn not to give importance to the OCD thoughts, in effect, revalue the thoughts as not important.
It was found that after the patients went through this therapy, not only their thoughts and behaviour changed, but their brains actually rewired! The hyperactivity that was seen in PET scans (a kind of medical imaging technology, like CT or MRI) had reduced a lot. This proved that the wiring of the brain was not fixed, but changeable. This phenomena, called ‘neuroplasticity’, broke the century old belief that brain is wired only up to the tender age of 5, and then remains unchanged throughout life.
We will take this thread further in the next article, where we will see how the brain gets wired in the early age, and what can make it change.

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