OCD “case study”

The context for this artistic endeavor was that I was working at the Institute of Psychiatry, London with Dr Ray Hodgson at the Addiction Research Unit and he had been researching the treatment of anxiety in general and compulsive behavior in particular with professors Isaac Marks, a psychiatrist, and Jack Rachman, a leading behavioral psychologist. They had been developing a technique called Cue Exposure with Response Prevention which was based on the idea that if you get people to face their fears rather than avoid them,anxiety will diminish. This led to some interesting scenarios with OCD sufferers. For example, I remember standing in, around and on garbage containers with people suffering from OCD contamination fears, ostensibly to show that nothing terrible happens when you expose yourself to germs (except you do tend to smell a bit).

The technique has proved useful in other areas, and my PhD was based on showing that you could use the technique to diminish craving and increase self-control in addicts. I composed this on my way to work one morning and Dr Rachman, an inveterate prankster who happened to be not only one of the leading psychologists of his time but also the editor of the journal Behavior Research and Therapy, published it.

Published in Behavior Research and Therapy

CASE HISTORIES AND SHORTER COMMUNICATIONS

Successful treatment of a compulsive limerick composer by behavioural methods

Summary: An odd patient is briefly explained, and the methods by which she was trained, to rid her in time, of compulsive rhyme, so that very little remained.

There are several syndromes quite new

That occasionally come into view

They appear in the clinics

And create many cynics

As to what should be done and by who.

This patient who hailed from Leeds

Was troubled by compulsive deeds

This led to the capers

Of searching through papers

To learn how treatment proceeds.

But to my deep and utter chagrin

I could nothing discover therein

That would serve as an aid

In my treating this maid,

And ridding her fully of sin.

The problem she had at this time

Manifested itself as a mime

For whenever she spoke

She either would choke

Or emit only five lines in rhyme.

Of all the patients to pick

I’d got one who really was sick

It was not a pose

There just was no prose

A slave to that old limerick.

A couple of weeks on one pill

Had little effect on this ill

Neither it seems

Did talking of dreams

Or toasting her lobe on the grill.

While walking one day in Belgravia,

Considering my role as her saviour

I suddenly thought

That I really ought

To look at my patient’s behaviour.

Having made a number of starts

I looked at the various parts

And immersed in my tables

And numerous labels

I explored this science of charts

From the consequent huge mass of data

Divulged by this suffering prose hater

A quick plan was mooted

And then instituted

That would help her sooner or later.

As aversion had ended in sparks

And implosion afforded no larks,

Off I did toddle

To try out the model

of Rachman, Hodgson, and Marks.

What this meant was response prevention

Which was well within my comprehension

While she fought with her urge

Her rhymes did she purge

Shouting phrases I could not right mention.

Proof that she’d lost her paralysis

Came in the MULVAR analysis

For no one can shun

A point 0 0 one*

Or talk of statistical fallacies.

After weeks of this kind of session

She partly had lost her obsession

Starting to write

All times of the night

In forms that did not really rhyme properly or scan.

As treatment progressed in this way

More words was she able to say,

That did not rhyme or scan in any manner. In fact, she could talk quite normally and hold perfectly reasonable conversations with all sorts of different people in any number of different situations. She would occasionally hiccup in rhyming couplets but it was felt that this too could be treated if it did not recover spontaneously.

At follow-up three months later

I collected a little more data

For she’d had a relapse

Brought on by collapse

And eventual demise of her pater.

However these problems were soon overcome and I am glad to report that this patient continues to make excellent progress. Replication of this unusual study is eagerly awaited.

Limerick Research Unit l0l Denmark Hill London SES 8AF, England

REFERENCES

Rachman S., Hodgson R. J. and Marks I. M. (1971)The treatment of chronic obsessive-compulsive neurosis. Behav. Res. & Therapy 9.237-247.

* normally written .oo1 or p<.001 meaning that the finding is likely to occur less than one in a thousand times.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: