Male2: It was important to treat this because not only was tormenting the parents, but the boy felt terrible, anything he touched, it was like it was—he was like a leper.
Male1: Why do you think it was?
Male2: Isaac Marx is a British psychiatrist, he was the one who figured this out. he said that obsessive compulsive disorder is lack of phobia in the following way. A person with a phobia makes himself or herself feel better by not going into the phobic situation, so if you are afraid to go on airplanes, you do not fly, and you feel better and what Isaac Marx said, it is that that the way you treat this though is you have got to get on the plane. Or if you fall off a horse on your face, you have got to get on the horse. You have to go do the thing that makes you scared if you do not overcome it. You can go to a psychiatrist forever and talk about this forever, but until you say you go into that elevator that you are afraid of, you are still going to be afraid no matter how much talk about the elevator and how it resembles something that scared you, got locked in a closet or something, you still have to develop a certain insight by living. In other words, you have to see that I can survive in the elevator. You get in the elevator and I tell people, if they do this, that they must stay in the elevator. They cannot go one flight and doors open and they get out and they feel like they did something. They did not. All they did was prove to themselves that getting off the elevator is the greatest thing that they could do. They have to stay in the elevator, ride up and down until they are sick and tired of this and that it is no longer scary, they had just had enough and then they can get off the elevator. Then they have learned that getting off the elevator is not the great thing that riding the elevator is not clearly dangerous.
So Isaac Marx said that the person who does the compulsion is making himself feel better, say by washing your hands and as long as they do that, they feel better. But it is like staying out of the elevator. Nothing gets better really, you just feel better for the time, he said, they need to not wash. Now I have had, I had one patient bringing in—he came in and I brought in a bucket of mud and he was a handwasher and I had him put his hands in the mud and was very uncomfortable and wanted to take pail of water to wash his hands, but I had explained this to him and he endured this. Sometimes at the home, he would wash immediately, but I told him that it is important not to go home and wash. He had paper towels so he could wipe off the mud and not drag it all over the place, but to go through the rest of the day without washing. I use the word insight before. There are different kinds of insight. I can explain to you that you do not get sick from mud or you do not—that touching your brother does not make everybody sick, he goes to school and the school is not dying. That may not really get to him just like if you were afraid of flying on airplanes, you know maybe that most people do not die if you look at an airplane and you do not think that that is going to fall out of the sky, but you feel like if you were in that airplane, you are going to fall out of the sky.
Male1: If behavior checkings do not work, medicine sometimes, does?
Male2: Yes, they are practically equally effective and interestingly, there was a famous study done because with some brain scans that use radioactive glucose and shows where the brain is more active, with people with obsessive compulsive disorder, the forebrain is active and when they are treated with medicine effectively, and they stop or they have less OCD that scan becomes normalized, but by this treatment which has a name that I am describing, it is called exposure and response prevention, you expose the person to the contamination r whatever and they prevent themselves from doing their cleaning, with exposure—you get the same result on the scans, the forebrain normalizes. So it is an interesting thing. The medicine and this non-medication treatment both work approximately equally. The best result actually tends to be using both of them.
Transcription by:
Scribe4you Transcription Services