Obsessive-compulsive disorder historical perspective
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Abhishek Reddy
Overview
Obsessive-compulsive disorder is an anxiety disorder. In obsessive-compulsive disorder people have unwanted and repeated thoughts, feelings, and ideas which are intrusive and unwanted, and are called obsessions. They also display behaviors called compulsions which are also unwanted, and negatively interfere with the sufferers life. The person often carries out these compulsions in order to rid themselves of the obsessive thoughts, but this only provides temporary relief. Not performing the obsessive rituals or tasks can cause the sufferer great anxiety.
Discovery
In the 1600s, having unwanted thoughts and establishing repetitive types of behavior in response, were seen as symptoms of melancholia. Melancholia is a severe form of depression in which a person loses the ability to enjoy any aspect of life at all. During this time when religious leaders served many roles within their local communities, such as preachers, doctors and judges the main cause of melancholia was seen as something that stemmed from a lack of being a devout religious practitioner.
In the 19th century as the emerging medical community started to separate themselves from the roles of religious authority, neurosis began to be seen as legitimate mental health issues rather than being a problem of those who were acting as less than devout. Throughout the development of the 19th century, ideas of what compulsions and personal obsessions were became a main area of study and analysis.
The start of the 20th century brought the largest advancement in the study of obsessions and compulsions as more psychiatrists started to link the two symptoms to one another. Sigmund Freud and Pierre Janet were the two most influential persons in bringing OCD to the level of understanding and diagnosis that we have as a combined disorder today . Freud’s concept brought together the idea of cause and effect, meaning that it was the obsessions that created the need for the compulsions or repetitive behaviors. While Janet put forth the idea that the cause of the obsessions stemmed from the inability of the person to use a particular type of nervous energy to complete high level of cognitive tasks, and so it was redirected into more primitive psychological activities such as focused obsessions and impulses.
The generic term "obsessive compulsive disorder" is not a term that was created in the traditional sense. No one person discovered "obsessive compulsive disorder" rather it was a collective effort of many mental health professionals over a period of many years. [1]
Development of Treatment Strategies
In this excerpt, psychiatrist Ian Osborn traces the history of medications for OCD since the 1960s.
The textbook I used in medical school (around 1970), Freedman and Kaplan's Comprehensive Textbook of Psychiatry, taught Freud's theories and suggested treating OCD with psychoanalysis. Regarding the use of medications, the authoritative text stated: "There are no drugs that have a specific action on the obsessive-compulsive symptoms...." I remember dutifully attempting to interpret my OCD patients' dreams in order to get to the roots of their unconscious conflicts, while avoiding prescribing anything....but in 1967, a Spanish psychiatrist, Lopez-Ibor, reported a drug that was specifically effective for OCD, clomipramine (Anafranil). Many case reports of its successful use followed, and in the 1980s more than fifteen double-blind and placebo controlled studies demonstrated beyond a doubt that it was a uniquely effective treatment for OCD.
Clomipramine was developed by chemists who added a chlorine atom to the molecular structure of the standard antidepressant imipramine in the hopes of finding a better antidepressant. Instead, fortuitously, the new agent was observed by psychiatrists to be helpful for OCD. Imipramine itself had been developed through experimental changes to the molecule of a certain antihistamine, done in the hope of building a better antihistamine. The compound was accidentally observed to work in the treatment of depression. All of the early breakthroughs in medication treatments for mental disorders were due to such serendipity.
In the 1970s, however, a remarkable advance in pharmacological research technique ushered in a whole new era in the development of drugs for psychiatric disorders. Solomon Snyder and colleagues at Johns Hopkins University developed a practical method of screening drugs for their effects on specific chemicals in the brain. The key discovery was finding a way to keep brain tissue chemically alive after an animal had been sacrificed. Using this technique, a rat could then be given a drug, sacrificed, and its brain tissue examined to see what effects that drug was having on various brain chemicals. Serendipity was no longer necessary. "Designer drugs" with specific effects on certain neurochemicals could now be developed.
Prozac, Luvox, Zoloft, and Paxil were all designer drugs, identified by their specific effects on serotonin. All have been proven very effective anti-OCD agents. Prozac was the first to be introduced in the United States. [2]
Famous Cases
Martin Luther (1483-1546), the first and most important leader of the Protestant Reformation in Europe suffered from OCD.
Dr. Samuel Johnson (1709-1784), accredited with compiling the first dictionary of the English language, suffered from a compulsion of ‘odd movements’.
Eminent evolutionist Charles Darwin (1809-1882) is now also widely accepted to have suffered from OCD.
Howard Hughes (1905 -1976) is perhaps the most famous person known to have suffered with OCD in more recent times who was the twentieth century American aviator, engineer, industrialist, film producer, film director, philanthropist, and one of the wealthiest people in the world, whose story was told in the 2004 film, ‘The Aviator’.