Obsessive-compulsive TV misconceptions

By Chris Hewitt
Knight Ridder News Service

In "Matchstick Men," Nicolas Cage plays an obsessive-compulsive con man. Warner Bros.

Monk, the hero of the TV show about a detective with obsessive-compulsive disorder, who is unable to look at Playboy magazine centerfolds, answer a public phone or unbutton the top button of his shirt, is not alone. The OCD narrator of Steve Martin's current best seller, "The Pleasure of My Company," spends all of his time doing number puzzles instead of actually meeting the woman he worships from afar. In "Matchstick Men," which comes out on video next month, Nicolas Cage plays an obsessive-compulsive con man who spends as much time vacuuming as flimflamming.

The disease in which a person's brain gets stuck on a certain thought (stepping on a sidewalk crack will kill you) or behavior (washing hands repeatedly), and can't let go of it, is hot in popular culture because it makes for entertaining character quirks. But experts say the way the disease is depicted is not so hot.

"Most people will never understand OCD and how serious it is. It's so foreign to people," says Dr. Suck Won Kim, associate professor of psychiatry at the University of Minnesota, who has treated thousands of patients with the disorder.

None was like the title character of the Emmy-winning "Monk," which opens its second season Friday on the USA Network. It's easier to remember what Monk is not afraid of than what he is. "Germs, needles, milk, death, snakes, mushrooms, heights, crowds, elevators" is the recent list Monk gave, but he left off public speaking, airplanes and a few of his other fears.

"Those are phobic disorders. They're not related to OCD at all. Many of them are forms of agoraphobia," says Kim. "I've seen over 2,000 patients with OCD, and none of them have complained of having trouble going on an airplane."

The specifics of the disease weren't important to director Ridley Scott when he was making "Matchstick Men" or conceiving Cage's character. "The disease itself doesn't interest me," Scott says. "What interests me is how it affects his ability to deal with other people."

For Cage's character and for Monk, germs are a big issue.

Whenever Monk reluctantly shakes someone's hands, his assistant, Sharona, hands him a disinfecting cloth — if it doesn't come quickly, he's been known to whine, "Wipe! Wipe! Wipe!"

Martin's main character in "The Pleasure of My Company," Daniel Cambridge, is similarly frightened of intimate contact. Both Monk and Cage's "Matchstick" character, Roy Waller, are compulsive cleaners who view Lysol as the only shield between them and certain death.

Perhaps the most famous example of pop-culture OCD is Jack Nicholson's Melvin Udall, in "As Good As It Gets," a sufferer who has clean-verging-on-raw hands.

"That does sound like OCD," says Kim. "If someone cleans all the time, if someone is a cleaning freak, that sounds like OCD. These people are very meticulous and tidy. They organize everything perfectly because they are compelled to do so. They don't want to clean obsessively, but they can't control it."

One characteristic of OCD is a compulsion to perform rituals — not just washing their hands but feeling compelled to wash them five times in a row. Or being forced to repeat number patterns, such as counting to five every time there's a knock on the door.

These kinds of rituals form a safety net for OCD sufferers, a sense that they are keeping the life-threatening dangers at bay.

Which is why it's extremely unlikely anyone with OCD could function successfully as a detective, as Monk does, or a con man, as Roy Waller does in "Matchstick Men."

Kim says OCD sufferers are statistically more likely to become lawyers or doctors, for whom repeated hand washing is good business (Michael J. Fox will play a doctor suffering from OCD on "Scrubs" next month).

Treatment is another issue movies and TV get wrong. Kim identifies two ways to treat patients: with drugs such as Prozac and Zoloft, and with "response prevention." If a patient is convinced that he will die unless he washes his hands five times after touching every doorknob, the doctor makes the patient touch a doorknob and then refuses to let him wash. Over the course of a couple of months, Kim says, this treatment can cure the patient of his compulsion, especially if it's paired with drugs.

Nicholson's character is the only character in pop culture who pursues these treatments. When he notes, near the end of the film, that "50 or 60 percent" of OCD sufferers respond to drugs, he's right.

The main thing popular culture gets wrong is that "Monk" and the others portray the disease like shyness, an obstacle that can be conquered with perseverance, instead of a serious disease.

What makes obsessive-compulsive disorder TV fodder?

What is compelling our obsession with obsessive-compulsive disorder?

The entertainment industry isn't really interested in the disorder, but filmmakers and writers are interested in new ways to tell stories. Expect to see more mental illnesses in pop culture because they provide an unusual perspective from which to look at the way people behave.

Literature has found a new way to create narrators whose perspective is unreliable because they suffer from a disorder that skews their way of looking at the world. Besides Daniel Cambridge in Steve Martin's "The Pleasure of My Company," who suffers from OCD, recent unreliable narrators have included the child storyteller in "The Curious Incident of the Dog in the Night-time," who is autistic, and the teenager who narrates "Motherless Brooklyn" and suffers from Tourette's syndrome.

These characters are as different from each other as Monk is from Roy Waller, Nicolas Cage's obsessive-compulsive con man in "Matchstick Men." But they do have some things in common. All use OCD as a metaphor to tell us something about the character, not something about the disease.

The show-biz OCD sufferer

1. Adrian Monk, "Monk."
2. Roy Waller, "Matchstick Men."
3. Daniel Cambridge, "The Pleasure of My Company."

How the disease supposedly works

1. It gives him a keen attention to detail, which helps him as a detective because it makes him good at evaluating crime scenes and sizing up suspects.
2. It makes him foresee every detail in his ripoffs, and it keeps him from forming attachments to any of the people he might want to rip off some day.
3. Childhood abuse dooms him to a life of fear, which he conquers by reaching out to a rambunctious child.

How it would really work

1. He wouldn't be able to collect evidence or collar suspects because he'd be afraid to touch anything.
2. He would be so busy vacuuming and counting that he'd never make it to a rendezvous with other con men.
3. The child would stick out his Gogurt-and juice-box-begrimed hand, and Daniel wouldn't be able to come within 10 feet of him.

What OCD is a metaphor for

1. His fear of reaching out to people.
2. His fear of reaching out to people.
3. His fear of reaching out to people.