DIAGNOSING OCD: THE REMARKABLE CASE OF HOWARD HUGHESthe best example of the depths of despair and disability to which this vicious cycle can carry a person is found, amazingly, in the case of a man who was once the richest person in America. Howard Hughes was a brilliant businessman, a pilot who set aviation records, a movie producer who courted beautiful starlets. Yet for the last twenty years of his life he lived as a complete recluse, spending his days in the darkened bedrooms of fancy penthouses with a small army of guards to insure his privacy. Newspapers portrayed him as an eccentric genius, but after his death in 1976 it was revealed that his strange behaviors were entirely due to compulsions run amok. As a young man Hughes was, indeed, eccentric. Perfectionistic and domineering, he wrote pages of memos on inconsequential items. Friends knew that he had irrational contamination fears; they were not allowed to even touch his private refrigerator. Nevertheless, despite such peculiarities, Hughes was enormously productive and successful. All this changed in midlife after he was severely injured in the crash of an air force reconnaissance plane of his own design and subsequently became addicted to the narcotics that were prescribed for the pain of his injuries.Thereafter, Hughes’ life was dominated by compulsions. Afraid to eat, drink, be touched, wear clothes, or leave his room, he made his staff follow senseless, intricate checking and washing rituals that took hours and hours to perform. A typical memo to his staff, instructions for the “preparation of canned fruit,” entailed no less than nine painstaking steps. Step 3, “washing of can,” for example, read:
The man in charge turns the valve in the bathtub on, using his bare hands to do so. He also adjusts the water temperature so that it is not too hot or too cold. He then takes one of the brushes, and, using one of the bars of soap, creates a good lather, and then scrubs the can from a point two inches below the top of the can. He should first soak and remove the label, and then brush the cylindrical part of the can over and over until all particles of dust, pieces of the label, and, in general, all sources of contamination have been removed. Holding the can in the center at all times, he then processes the bottom of the can in the same manner, being very sure that the bristles of the brush have thoroughly cleaned all the small indentations on the perimeter. He then rinses the soap. Taking the second brush, and still holding the can in the center, he again creates a good lather and scrubs the top of the can, the perimeter along the top, and the cylindrical sides to a point two inches below the top. He should continue this scrubbing until he literally removes the tin protection from the can itself.
Every other step is comparably detailed. From step 5: “While transferring the fruit from the can to the sterile plate, be sure that no part of the body, including the hands, be directly over the can or the plate at any time. If possible, keep the head, upper part of the body, arms, etc. at least one foot away.” The memo finishes: “This operation must be carried out in every infinitesimal detail, and I would deeply appreciate it if the man would follow each phase very slowly and thoughtfully, giving his full attention to the importance of the work at hand.”Hughes’ germ obsessions, paradoxically, drove him to hoarding whatever might cause contamination. His urine and feces was stored in large jars. He lived out his years in a tortured, solitary manner, his OCD relieved only by fixes of narcotic drugs.The case of Howard Hughes is, indeed, very strange. Not only were his compulsions extraordinary, but it is almost unheard of for a person to develop such a severe case after age fifty. The objective observer must wonder whether Hughes’ caretakers were purposefully keeping him disabled in order to take advantage of his wealth. His ability to cope with obsessions was certainly compromised when they helped him become addicted to narcotics. His OCD, it would appear, was also markedly worsened when they carried out what was in essence an “anti-behavior therapy” program, fully assisting in all of his wild rituals. Most tellingly, these assistants never tried to get Hughes any treatment. A physician remarked after his death: “He would have gotten better care if he were a penniless wino who collapsed on skid row. At least some passer-by would have called the paramedics.”*12/338/2*
the best example of the depths of despair and disability to which this vicious cycle can carry a person is found, amazingly, in the case of a man who was once the richest person in America. Howard Hughes was a brilliant businessman, a pilot who set aviation records, a movie producer who courted beautiful starlets. Yet for the last twenty years of his life he lived as a complete recluse, spending his days in the darkened bedrooms of fancy penthouses with a small army of guards to insure his privacy. Newspapers portrayed him as an eccentric genius, but after his death in 1976 it was revealed that his strange behaviors were entirely due to compulsions run amok. As a young man Hughes was, indeed, eccentric. Perfectionistic and domineering, he wrote pages of memos on inconsequential items. Friends knew that he had irrational contamination fears; they were not allowed to even touch his private refrigerator. Nevertheless, despite such peculiarities, Hughes was enormously productive and successful. All this changed in midlife after he was severely injured in the crash of an air force reconnaissance plane of his own design and subsequently became addicted to the narcotics that were prescribed for the pain of his injuries.
Thereafter, Hughes’ life was dominated by compulsions. Afraid to eat, drink, be touched, wear clothes, or leave his room, he made his staff follow senseless, intricate checking and washing rituals that took hours and hours to perform. A typical memo to his staff, instructions for the “preparation of canned fruit,” entailed no less than nine painstaking steps. Step 3, “washing of can,” for example, read:
The man in charge turns the valve in the bathtub on, using his bare hands to do so. He also adjusts the water temperature so that it is not too hot or too cold. He then takes one of the brushes, and, using one of the bars of soap, creates a good lather, and then scrubs the can from a point two inches below the top of the can. He should first soak and remove the label, and then brush the cylindrical part of the can over and over until all particles of dust, pieces of the label, and, in general, all sources of contamination have been removed. Holding the can in the center at all times, he then processes the bottom of the can in the same manner, being very sure that the bristles of the brush have thoroughly cleaned all the small indentations on the perimeter. He then rinses the soap. Taking the second brush, and still holding the can in the center, he again creates a good lather and scrubs the top of the can, the perimeter along the top, and the cylindrical sides to a point two inches below the top. He should continue this scrubbing until he literally removes the tin protection from the can itself.
Every other step is comparably detailed. From step 5: “While transferring the fruit from the can to the sterile plate, be sure that no part of the body, including the hands, be directly over the can or the plate at any time. If possible, keep the head, upper part of the body, arms, etc. at least one foot away.” The memo finishes: “This operation must be carried out in every infinitesimal detail, and I would deeply appreciate it if the man would follow each phase very slowly and thoughtfully, giving his full attention to the importance of the work at hand.”
Hughes’ germ obsessions, paradoxically, drove him to hoarding whatever might cause contamination. His urine and feces was stored in large jars. He lived out his years in a tortured, solitary manner, his OCD relieved only by fixes of narcotic drugs.
The case of Howard Hughes is, indeed, very strange. Not only were his compulsions extraordinary, but it is almost unheard of for a person to develop such a severe case after age fifty. The objective observer must wonder whether Hughes’ caretakers were purposefully keeping him disabled in order to take advantage of his wealth. His ability to cope with obsessions was certainly compromised when they helped him become addicted to narcotics. His OCD, it would appear, was also markedly worsened when they carried out what was in essence an “anti-behavior therapy” program, fully assisting in all of his wild rituals. Most tellingly, these assistants never tried to get Hughes any treatment. A physician remarked after his death: “He would have gotten better care if he were a penniless wino who collapsed on skid row. At least some passer-by would have called the paramedics.”
*12/338/2*
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